| 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 | $15K | — | $15K | 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 | $6K | $4K | $10K | 10.70% |
| PCS INSURANCE SERVICES INC3 | 702 E MAIN ST MURFREESBORO, TN 37130 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9K | — | $9K | 10.47% |
| WORKSITE BENEFITS GROUP INC3 | 112 NW 114TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $2K | $3K | 3.35% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $774 | $3K | 3.23% |
| DAVID KINNEY3 | 802 NEVADA DR LONGVIEW, WA 98632 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $275 | $2K | 1.71% |
| PAMELA COPLE SMITH3 | 411 HIGHLAND DR SEATTLE, WA 98109 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $40 | $1K | 1.57% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF OREGON LLC | C/O BROWN BROWN NORTHWEST PORTLAND, OR 97296 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $286 | $88 | $374 | 0.42% |
| GABRIEL ANGEL CANALS3 | 1549 NW CIVIC DR APT 204 GRESHAM, OR 97030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $74 | $201 | $275 | 0.31% |
| TRICIA MILLER3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $219 | $7 | $226 | 0.25% |
| ROXANA BUSCHMAN3 | 400 NE 149TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $146 | — | $146 | 0.16% |
| ISAACSON INSURANCE AGENCY LLC3 | 1250 11TH ST WEST LINN, OR 97068 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $44 | $6 | $50 | 0.06% |
| MEGAN ELIZABETH CASTO3 | HOME OFFICE COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $9 | $25 | 0.03% |
| JUDY INEZ BUCHOLTZ3 | 12517-217TH AVE CT E BONNEY LAKE, WA 98391 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $1 | $17 | 0.02% |
| RAQUEL LOSADA MONROY3 | 817 NE DELP RD CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $1 | $8 | 0.01% |
| PCS INSURANCE SERVICES INC3 | 702 E MAIN ST MURFREESBORO, TN 37130 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $683 | — | $683 | 9.80% |
| HEASTSEASE LLC3 | 1521 NE 63RD AVE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $76 | $25 | $101 | 1.45% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $37 | $7 | $44 | 0.63% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF OREGON LLC | C/O BROWN AND BROWN NORTHWEST PORTLAND, OR 97296 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.09% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF OREGON LLC | D/B/A FULLERTON COMPANY INC PO BOX 29018 PORTLAND, OR 97296 | METROPOLITAN LIFE INSURANCE COMPANY | $138 | $17 | $155 | — |
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 | 190 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 193 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS | 402 | $153K |
| Vision(2 contracts, 2 carriers) | AMERITAS | 402 | $153K |
| Life insurance(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 333 | $97K |
| Other(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 333 | $97K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 402 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.