| 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% |
| PCS INSURANCE SERVICES INC3 | 702 E MAIN ST MURFREESBORO, TN 37130 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11K | — | $11K | 9.84% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | $2K | $7K | 6.71% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $822 | $3K | 2.88% |
| DAVID KINNEY3 | 802 NEVADA DR LONGVIEW, WA 98632 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $729 | $3K | 2.36% |
| TRICIA MILLER3 | 2101 279TH ST NE RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $347 | $2 | $349 | 0.32% |
| WORKSITE BENEFITS GROUP INC3 | 112 NW 114TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $312 | $1 | $313 | 0.29% |
| 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 | $312 | $1 | $313 | 0.29% |
| COREY ROBERT PALMER3 | 3802 CELEBRATION LANE NW CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $183 | $104 | $287 | 0.26% |
| ROXANA BUSCHMAN3 | 400 NE 149TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $237 | $6 | $243 | 0.22% |
| PAMELA COPLE SMITH3 | 411 HIGHLAND DR SEATTLE, WA 98109 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $230 | — | $230 | 0.21% |
| SUSAN MAE DANIEL3 Filed as: SUSAN LEACH | 4419 131ST PL, APT, C1 PORTLAND, OR 97230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $195 | $8 | $203 | 0.19% |
| GABRIEL ANGEL CANALS3 | 1549 NW CIVIC DR APT 204 GRESHAM, OR 97030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $97 | $97 | $194 | 0.18% |
| ISAACSON INSURANCE AGENCY LLC3 | 1250 11TH ST WEST LINN, OR 97068 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $58 | $13 | $71 | 0.06% |
| RAQUEL LOSADA MONROY3 | 817 NE DELP RD CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $49 | $12 | $61 | 0.06% |
| MELISSA CATHLEEN HADLOCK3 | 14912 249TH ST NE BATTLE GROUND, WA 98604 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $3 | $29 | 0.03% |
| ADAM ANTHONY ANDELIN3 | 9217 SILVERBEND LN ELK GROVE, CA 95624 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.02% |
| SAMAR BREIK ALBIN3 | 41572 VALOR DR MURRIETA, CA 92562 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.00% |
| PCS INSURANCE SERVICES INC3 | 702 E MAIN ST MURFREESBORO, TN 37130 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $732 | — | $732 | 9.01% |
| HEASTSEASE LLC3 | 1521 NE 63RD AVE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $82 | $18 | $100 | 1.23% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | $6 | $46 | 0.57% |
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 | 313 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 313 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS | 433 | $149K |
| Vision | AMERITAS | 433 | $149K |
| Life insurance(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 313 | $117K |
| Other(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 313 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 433 | — |
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.