| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA PCS INSURANCE SERVICES INC 702 E MAIN ST MURFREESBORO, TN 37130 | AMERITAS | $16K | — | $16K | 10.00% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSUR & FINANCIAL SRVCS | 12404 PARK CENTRAL DR. STE 400S DALLAS, TX 75251 | AMERITAS | $6K | — | $6K | 4.00% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7K | $3K | $10K | 9.88% |
| WORKSITE BENEFITS GROUP INC3 | 112 NW 114TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $3K | $4K | 4.21% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA PCS INSURANCE SERVICES INC CHICO, CA 95926 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 3.92% |
| ACRISURE LLC3 Filed as: ACRISURE TEXAS RISK ADVISORS & INS | 5057 KELLER SPRINGS RD ADDISON, TX 75001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 3.56% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $849 | $3K | 3.10% |
| PCS INSURANCE SERVICES INC3 | 702 E MAIN ST MURFREESBORO, TN 37130 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 2.06% |
| DAVID KINNEY3 | 802 NEVADA DR LONGVIEW, WA 98632 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $306 | $2K | 2.03% |
| TRICIA MILLER3 | 2101 279TH ST NE RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $380 | — | $380 | 0.39% |
| PAMELA COPLE SMITH3 | 411 HIGHLAND DR SEATTLE, WA 98109 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $349 | — | $349 | 0.35% |
| GABRIEL ANGEL CANALS3 | 1549 NW CIVIC DR APT 204 GRESHAM, OR 97030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $110 | $187 | $297 | 0.30% |
| RAQUEL LOSADA MONROY3 | 817 NE DELP RD CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $243 | $48 | $291 | 0.30% |
| ROXANA BUSCHMAN3 | 400 NE 149TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $274 | — | $274 | 0.28% |
| SILVIA C HERNANDEZ3 | 4785 DIAMOND CT NE SALEM, OR 97305 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $248 | $8 | $256 | 0.26% |
| HOLLI M GUIER3 | 602 NE 103RD CT VANCOUVER, WA 98664 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $128 | $40 | $168 | 0.17% |
| ISAACSON INSURANCE AGENCY LLC3 | 1250 11TH ST WEST LINN, OR 97068 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $102 | $24 | $126 | 0.13% |
| SUSAN MAE DANIEL3 Filed as: SUSAN LEACH | 4419 131ST PL, APT, C1 PORTLAND, OR 97230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $77 | $4 | $81 | 0.08% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN AND BROWN OF OREGON LLC | C/O BROWN BROWN NORTHWEST PORTLAND, OR 97296 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $44 | — | $44 | 0.04% |
| MELISSA CATHLEEN HADLOCK3 | 14912 249TH ST NE BATTLE GROUND, WA 98604 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.04% |
| COREY ROBERT PALMER3 | 3802 CELEBRATION LANE NW CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | $6 | $25 | 0.03% |
| KELLY ROSS SURGEON3 | 1419 28TH AVE STE B LEWISTON, ID 83501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $8 | $15 | 0.02% |
| DENIS A MAXWELL3 | 4273 E BELLINA LN MERIDIAN, ID 83642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $1 | $8 | 0.01% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INS SVCS | C/O BROWN BROWN NW PORTLAND, OR 97296 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA PCS INSURANCE SERVICES INC CHICO, CA 95926 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $251 | — | $251 | 3.76% |
| ACRISURE LLC3 Filed as: ACRISURE TEXAS RISK ADVISORS * INS | 5057 KELLER SPRINGS RD ADDISON, TX 75001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $222 | — | $222 | 3.32% |
| PCS INSURANCE SERVICES INC3 | 702 E MAIN ST MURFREESBORO, TN 37130 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $146 | — | $146 | 2.19% |
| HEASTSEASE LLC3 | 1521 NE 63RD AVE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $69 | $12 | $81 | 1.21% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $34 | $5 | $39 | 0.58% |
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 | 198 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 198 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS | 435 | $156K |
| Vision | AMERITAS | 435 | $156K |
| Life insurance(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 298 | $105K |
| Other(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 298 | $105K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 435 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.