| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | MODA, INC. | $27K | — | $27K | 0.92% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | WILLAMETTE DENTAL INSURANCE, INC. | $56K | — | $56K | 3.00% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | THE LINCOLN NATIONAL LIFE INS. CO. | $87K | — | $87K | 6.50% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | THE LINCOLN NATIONAL LIFE INS. CO. | $74K | — | $74K | 6.86% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | THE LINCOLN NATIONAL LIFE INS. CO. | $50K | — | $50K | 8.38% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | THE LINCOLN NATIONAL LIFE INS. CO. | $47K | — | $47K | 9.94% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | LIFEMAP ASSURANCE COMPANY | $85K | — | $85K | 18.29% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | THE LINCOLN NATIONAL LIFE INS. CO. | $25K | — | $25K | 9.91% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 2.66% |
| BENEFIT COMMUNICATIONS INC0 Filed as: BENEFIT COMMUNICATIONS INC. | 2977 SIDCO DR NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 1.88% |
| CHRISTOPHER R MORRIS3 | 2977 SIDCO DR NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.61% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $18 | $25 | 0.02% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $23K | — | $23K | 14.80% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | THE LINCOLN NATIONAL LIFE INS. CO. | $12K | — | $12K | 9.95% |
| BARKER-UERLINGS INSURANCE3 | 340 NW 5TH STREET CORVALLIS, OR 97330 | ACE AMERICAN INSURANCE COMPANY | $285 | — | $285 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILLAMETTE DENTAL INSURANCE, INC. EIN 93-1171647 CONTRACT | Contract Administrator Service code 13 | 6950 NE CAMPUS WAY HILLSBORO, OR 97124 | $113K |
| PACIFIC SOURCE ADMINISTRATORS EIN 30-0140934 CONTRACT | Contract Administrator Service code 13 | PO BOX 70168 EUGENE, OR 97401 | $67K |
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 | 4,997 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 38 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 5,035 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | MODA, INC. | 2,431 | $4.8M |
| Life insurance(3 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INS. CO. | 4,997 | $1.2M |
| Short-term disability(3 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INS. CO. | 2,544 | $1.5M |
| Long-term disability | THE LINCOLN NATIONAL LIFE INS. CO. | 4,969 | $1.3M |
| Other(5 contracts, 4 carriers) | THE LINCOLN NATIONAL LIFE INS. CO. | 4,997 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,997 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.