| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| K.P.D. INSURANCE, LLC3 Filed as: K. P. D. INSURANCE, LLC. | PO BOX 784 SPRINGFIELD, OR 97477 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $24K | $62 | $24K | 2.05% |
| K.P.D. INSURANCE, LLC3 Filed as: K. P. D. INSURANCE, LLC. | 1111 GATEWAY LOOP SPRINGFIELD, OR 97477 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $0 | $3K | 3.89% |
| MARCI MARIE OTIS3 | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $1K | $0 | $1K | 4.15% |
| CAROL A. KENYON3 | 1645 CLEVELAND HILL ROAD ROSEBURG, OR 97471 | AFLAC | $626 | $0 | $626 | 2.11% |
| JOSEPH FIDDY INC3 Filed as: JOSEPH FIDDY, INC. | 2000 WEST HARVARD AVENUE SUITE 100 ROSEBURG, OR 97471 | AFLAC | $467 | $0 | $467 | 1.58% |
| SHAWN M. OTIS3 Filed as: SHAWN MICHAEL OTIS AND OTHER AGENTS | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $339 | $0 | $339 | 1.14% |
| NOAH BAILEY3 | 201 WEST MAIN STREET SUITE 4A MEDFORD, OR 97501 | AFLAC | $170 | $0 | $170 | 0.57% |
| GUY R SOUTER3 Filed as: GUY R. SOUTER | 1930 VILLAGE CENTER CIRCLE SUITE 3 PMB 5962 LAS VEGAS, NV 89134 | AFLAC | $49 | $0 | $49 | 0.17% |
| JAMES S SARANTIS3 Filed as: JAMES S. SARANTIS | 14132 SE FIRCREST COURT PORTLAND, OR 97236 | AFLAC | $45 | $0 | $45 | 0.15% |
| K.P.D. INSURANCE, LLC3 Filed as: K. P. D. INSURANCE, LLC. | PO BOX 784 SPRINGFIELD, OR 97477 | VISION SERVICE PLAN | $842 | $0 | $842 | 6.67% |
| K.P.D. INSURANCE, LLC3 Filed as: K. P. D. INSURANCE, LLC. | PO BOX 784 SPRINGFIELD, OR 97477 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 15.00% |
| IMA, INC.3 | PO BOX 2992 WICHITA, KS 67201 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $786 | $786 | 6.39% |
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 | 130 | 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) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 189 | $1.2M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 307 | $105K |
| Vision(2 contracts, 2 carriers) | AFLAC | 79 | $42K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 130 | $42K |
| Short-term disability | AFLAC | 37 | $30K |
| Prescription drug | REGENCE BLUECROSS BLUESHIELD OF OREGON | 189 | $1.2M |
| Other(2 contracts, 2 carriers) | AFLAC | 130 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 307 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.