| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $40K | — | $40K | 0.92% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $37K | $5K | $42K | 17.75% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 2.29% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 555 PLEASANTVILLE ROAD BRIARCLIFF MANOR, NY 10510 | STANDARD INSURANCE COMPANY | — | $1K | $1K | 0.91% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | PACIFICSOURCE HEALTH PLANS | $2K | — | $2K | 2.14% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | VISION SERVICE PLAN | $888 | — | $888 | 6.40% |
| LINDA A. RASKIND3 | 14685 SE 130TH DRIVE CLACKAMAS, OR 97015 | CONTINENTAL AMERICAN INSURANCE COMPANY | $309 | — | $309 | 3.96% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | CONTINENTAL AMERICAN INSURANCE COMPANY | $265 | — | $265 | 3.39% |
| MELISSA M MORGAN3 Filed as: MELISSA M. MORGAN | 1602 SE 146 COURT VANCOUVER, WA 98683 | CONTINENTAL AMERICAN INSURANCE COMPANY | $127 | — | $127 | 1.63% |
| MJ INSURANCE3 Filed as: CHRISTOPHER HOFF AND VARIOUS AGENTS | 5665 MEADOWS ROAD, SUITE 140 LAKE OSWEGO, OR 97035 | CONTINENTAL AMERICAN INSURANCE COMPANY | $114 | — | $114 | 1.46% |
| STEPHANIE JOELAINE THOMAS ROID3 Filed as: STEPHANIE THOMAS-ROID | 515 NW SALTZMAN, SUITE 728 PORTLAND, OR 97229 | CONTINENTAL AMERICAN INSURANCE COMPANY | $92 | — | $92 | 1.18% |
| SHANE SCALF3 | 809 NE 10TH STREET BATTLEGROUND, WA 98604 | CONTINENTAL AMERICAN INSURANCE COMPANY | $84 | — | $84 | 1.08% |
| ERIC DANIEL WEILAND3 Filed as: ERIC D. WEIDLAND | 14511 SW CORNERSTONE LANE SHERWOOD, OR 97140 | CONTINENTAL AMERICAN INSURANCE COMPANY | $60 | — | $60 | 0.77% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $84 | — | $84 | 4.19% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $28 | — | $28 | 1.40% |
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 | 934 | 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) | 934 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 598 | $4.4M |
| Dental(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 598 | $4.4M |
| Vision | VISION SERVICE PLAN | 131 | $14K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 734 | $236K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 734 | $238K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 734 | $236K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 598 | $4.4M |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 934 | $273K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 934 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.