| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INSURANCE SVCS., INC. | 1325 4TH AVENUE, SUITE 1705 SEATTLE, WA 98101 | PACIFICSOURCE HEALTH PLANS | $81K | $3K | $84K | 3.18% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INSURANCE SVCS., INC. | 80 SOUTH 8TH STREET, SUITE 1800 MINNEAPOLIS, MN 55402 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $10K | $0 | $10K | 7.27% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $40 | $40 | 0.03% |
| KATE THOMAS GROUP INC3 Filed as: KATE THOMAS GROUP, INC. | 2660 NE HIGHWAY 20, SUITE 610 332 BEND, OR 97701 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | $0 | $4K | 11.65% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INSURANCE SVCS., INC. | 901 MARQUETTE AVENUE, SUITE 1800 MINNEAPOLIS, MN 55402 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | $0 | $2K | 5.74% |
| RYAN GEORGE KRUIT3 | 612 GLENEDEN PLACE BEND, OR 97702 | CONTINENTAL AMERICAN INSURANCE COMPANY | $610 | $0 | $610 | 2.01% |
| JAMES S SARANTIS3 Filed as: JAMES STEPHEN SARANTIS | 14132 SE FIRCREST COURT PORTLAND, OR 97236 | CONTINENTAL AMERICAN INSURANCE COMPANY | $501 | $0 | $501 | 1.65% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN OF WASHINGTON, INC. | 2106 PACIFIC AVENUE, SUITE 501 TACOMA, WA 98402 | CONTINENTAL AMERICAN INSURANCE COMPANY | $198 | $0 | $198 | 0.65% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN OF OREGON, LLC | 2701 NW VAUGHN STREET, SUITE 340 PORTLAND, OR 97210 | CONTINENTAL AMERICAN INSURANCE COMPANY | $34 | $0 | $34 | 0.11% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 201 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 201 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 253 | $2.6M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 201 | $131K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 201 | $131K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 201 | $131K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 253 | $2.6M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 201 | $162K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 253 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.