| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JEANINE L. JENSEN3 | PO BOX 745977 LOS ANGELES, CA 90074 | PACIFICSOURCE HEALTH PLANS | $15K | $0 | $15K | 1.09% |
| JEANINE L. JENSEN3 | 450 COUNTRY CLUB ROAD, SUITE 340 EUGENE, OR 97401 | PACIFICSOURCE HEALTH PLANS | $7K | $0 | $7K | 0.51% |
| PACIFIC BENEFIT CONSULTANTS3 | 450 COUNTRY CLUB ROAD, SUITE 330 EUGENE, OR 97401 | PACIFICSOURCE HEALTH PLANS | $1K | $0 | $1K | 0.08% |
| ALLIANT INSURANCE SERVICES, INC.3 | PO BOX 745977 LOS ANGELES, CA 90074 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $1K | $0 | $1K | 1.72% |
| PACIFIC BENEFIT CONSULTANTS3 | 450 COUNTRY CLUB ROAD, SUITE 330 EUGENE, OR 97401 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $925 | $0 | $925 | 1.27% |
| ALLIANT INSURANCE SERVICES, INC.3 | 18100 VON KARMAN AVENUE, 10TH FLOOR IRVINE, CA 92612 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $160 | $4K | 11.68% |
| PACIFIC BENEFIT CONSULTANTS3 | 450 COUNTRY CLUB ROAD, SUITE 330 EUGENE, OR 97401 | VISION SERVICE PLAN | $729 | $0 | $729 | 5.81% |
| ALLIANT INSURANCE SERVICES, INC.3 | 450 COUNTRY CLUB ROAD, SUITE 330 EUGENE, OR 97401 | VISION SERVICE PLAN | $294 | $0 | $294 | 2.34% |
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 | 127 | 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) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 99 | $1.4M |
| Dental | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 135 | $73K |
| Vision(2 contracts, 2 carriers) | PACIFICSOURCE HEALTH PLANS | 99 | $1.4M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 127 | $38K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 127 | $38K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 99 | $1.4M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 127 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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.