| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | OREGON DENTAL SERVICE | — | — | $0 | 0.00% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | WILLAMETTE DENTAL INSURANCE, INC. | — | — | $0 | 0.00% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $48K | — | $48K | 2.50% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $41K | — | $41K | 2.50% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $32K | — | $32K | 2.50% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $11K | — | $11K | 2.48% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $10K | — | $10K | 2.50% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $84K | — | $84K | 22.99% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $66K | — | $66K | 23.48% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 2.50% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $23K | — | $23K | 15.63% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | — | $5K | 3.32% |
| BENEFIT COMMUNICATIONS INC0 Filed as: BENEFIT COMMUNICATIONS INC. | 2977 SIDCO DR NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.74% |
| CHRISTOPHER R MORRIS3 | 2977 SIDCO DR NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $313 | — | $313 | 0.23% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS INC. | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.02% |
| TIMOTHY HENNESSY3 | PO BOX 1185 CORVALLIS, OR 973391185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 2.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 340 NW 5TH STREET CORVALLIS, OR 97330 | ACE AMERICAN INSURANCE COMPANY | $307 | — | $307 | 16.16% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILLAMETTE DENTAL INSURANCE, INC. EIN 93-1171647 CONTRACT | Contract Administrator Service code 13 | 6950 NE CAMPUS WAY HILLSBORO, OR 97124 | $124K |
| PACIFIC SOURCE ADMINISTRATORS EIN 30-0140934 CONTRACT | Contract Administrator Service code 13 | PO BOX 70168 EUGENE, OR 97401 | $83K |
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 | 5,298 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 131 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 5,429 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | OREGON DENTAL SERVICE | 2,788 | $5.8M |
| Life insurance(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 5,298 | $1.9M |
| Short-term disability(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,446 | $2.2M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 5,274 | $1.9M |
| Other(6 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 5,298 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,298 | — |
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."
No prospect flags tripped on this filing.