| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING CO. | DBA USI INSURANCE SERVICES NW 825 NE MULTNOMAH ST, STE 1500 PORTLAND, OR 97232 | PACIFICSOURCE HEATLTH PLANS | $54K | — | $54K | 2.62% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62683 VIRGINIA BEACH, VA 23466 | THE HARTFORD | $11K | — | $11K | 16.36% |
| USI INSURANCE SERVICES LLC3 | 470 PARK AVENUE SOUTH FLOOR 6 NEW YORK, NY 10016 | THE HARTFORD | — | $2K | $2K | 2.42% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING CO. | DBA USI NORTHWEST 825 NE MULTNOMAH ST, STE 1500 PORTLAND, OR 97232 | WILLAMETTE DENTAL GROUP | $5K | — | $5K | 8.00% |
| MARCI MARIE OTIS3 Filed as: MARCI M. OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | — | $4K | 12.12% |
| CAROL A. KENYON3 Filed as: CAROL A KENYON | 1641 CLEVELAND HILL ROAD ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3K | — | $3K | 9.76% |
| JEROMY E. CILLEY3 Filed as: JEROMY E CILLEY | 1115 PEARL STREET EUGENE, OR 97401 | CONTINENTAL AMERICAN INSURANCE COMPANY | $659 | — | $659 | 1.95% |
| SHAWN M. OTIS3 Filed as: SHAWN M OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $168 | — | $168 | 0.50% |
| MARK D LUTHER3 | 804 MOOREFIE LD PARK DRIVE SUITE 106 RICHMOND, VA 23236 | CONTINENTAL AMERICAN INSURANCE COMPANY | $162 | — | $162 | 0.48% |
| RAYMON P KEECH III3 | 8207 CAMPAIGN CIRCLE RICHMOND, TX 77406 | CONTINENTAL AMERICAN INSURANCE COMPANY | $112 | — | $112 | 0.33% |
| TYLER M. OTIS3 | 200 JULINA LANE ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $33 | — | $33 | 0.10% |
| KIMBERLY A PARKS3 Filed as: KIMBERLY A. PARKS | 19818 N 147TH DR SUN CITY WEST, AZ 85375 | CONTINENTAL AMERICAN INSURANCE COMPANY | $21 | — | $21 | 0.06% |
| SHANE EDMUND ATTEBERY3 Filed as: SHANE E ATTEBERY | 2824 S RIVER ROAD GRANTS PASS, OR 97527 | CONTINENTAL AMERICAN INSURANCE COMPANY | $11 | — | $11 | 0.03% |
| GUY R SOUTER3 | 2350 OAKMONT WAY STE 207 EUGENE, OR 97401 | CONTINENTAL AMERICAN INSURANCE COMPANY | $8 | — | $8 | 0.02% |
| MATTHEW S SHROYER3 | 7407 N WILLIAMS AVE PORTLAND, OR 97217 | CONTINENTAL AMERICAN INSURANCE COMPANY | $6 | — | $6 | 0.02% |
| RICHARD E. SYFERT3 Filed as: RICHARD E SYFERT | PO BOX 2079 JASPER, OR 97438 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| CHRISTOPHER E. RUSSELL3 | 1895 W. 17TH AVE. EUGENE, OR 97402 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2 | — | $2 | 0.01% |
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 | 244 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 244 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEATLTH PLANS | 243 | $2.1M |
| Dental(2 contracts, 2 carriers) | PACIFICSOURCE HEATLTH PLANS | 243 | $2.1M |
| Vision | PACIFICSOURCE HEATLTH PLANS | 243 | $2.1M |
| Life insurance | THE HARTFORD | 244 | $69K |
| Short-term disability | THE HARTFORD | 244 | $69K |
| Long-term disability | THE HARTFORD | 244 | $69K |
| Prescription drug | PACIFICSOURCE HEATLTH PLANS | 243 | $2.1M |
| Other(3 contracts, 3 carriers) | THE HARTFORD | 244 | $164K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 244 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.