| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TYLER OLIVER3 | KIBBLE AND PRENTICE HOLDING CO DBA 825 NE MULTNOMAH ST. STE 1500 PORTLAND, OR 97232 | PACIFICSOURCE HEALTH PLANS | $5K | — | $5K | 0.21% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62683 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $5K | — | $5K | 6.74% |
| WARD INSURANCE AGENCY INC3 Filed as: WARD INSURANCE AGENCY INC. | PO BOX 10167 EUGENE, OR 97440 | HARTFORD LIFE AND ACCIDENT | $3K | — | $3K | 4.02% |
| USI INSURANCE SERVICES LLC3 | ENTERPRISE LICENSING CENTER 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | HARTFORD LIFE AND ACCIDENT | — | $2K | $2K | 2.46% |
| MARCI MARIE OTIS3 Filed as: MARCI M OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3K | — | $3K | 7.38% |
| CAROL A. KENYON3 Filed as: CAROL A KENYON | 1641 CLEVELAND HILL ROAD ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | — | $2K | 6.53% |
| RICHARD E. SYFERT3 Filed as: RICHARD E SYFERT | PO BOX 2079 JASPER, OR 97438 | CONTINENTAL AMERICAN INSURANCE COMPANY | $501 | — | $501 | 1.39% |
| JEROMY E. CILLEY3 Filed as: JEROMY E CILLEY | 1115 PEARL STREET EUGENE, OR 97401 | CONTINENTAL AMERICAN INSURANCE COMPANY | $239 | — | $239 | 0.66% |
| CHRISTOPHER E. RUSSELL3 Filed as: CHRISTOPHER E RUSSELL | 1895 W 17TH AVE EUGENE, OR 97402 | CONTINENTAL AMERICAN INSURANCE COMPANY | $226 | — | $226 | 0.63% |
| SHAWN M. OTIS3 Filed as: SHAWN M OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $157 | — | $157 | 0.43% |
| 9999MARK D LUTHER3 | 804 MOOREFIELD PARK DR SUITE 106 RICHMOND, VA 23236 | CONTINENTAL AMERICAN INSURANCE COMPANY | $150 | — | $150 | 0.42% |
| RAYMON P KEECH III3 | 8207 CHAMPAIGN CIRCLE RICHMOND, TX 77406 | CONTINENTAL AMERICAN INSURANCE COMPANY | $103 | — | $103 | 0.29% |
| KIMBERLY A PARKS3 | 19818 N 147 AVE SUN CITY WEST, AZ 85375 | CONTINENTAL AMERICAN INSURANCE COMPANY | $21 | — | $21 | 0.06% |
| TYLER M. OTIS3 Filed as: TYLER OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $19 | — | $19 | 0.05% |
| SHANE EDMUND ATTEBERY3 Filed as: SHANE E ATTEBERY | 2824 S RIVER ROAD GRANTS PASS, OR 97527 | CONTINENTAL AMERICAN INSURANCE COMPANY | $11 | — | $11 | 0.03% |
| MATTHEW S SHROYER3 | 7407 N WILLIAMS AVE PORTLAND, OR 97217 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| GUY R SOUTER | 2350 OAKMONT WAY STE 207 EUGENE, OR 97401 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WARD INSURANCE AGENCY EIN 93-0963467 INSURANCE AGENT | Insurance agents and brokers Service code 22 | PO BOX 10167 EUGENE, OR 97440 | $25K |
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 | 251 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 251 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 250 | $2.2M |
| Dental(2 contracts, 2 carriers) | PACIFICSOURCE HEALTH PLANS | 250 | $2.2M |
| Vision | PACIFICSOURCE HEALTH PLANS | 250 | $2.2M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 251 | $77K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 251 | $77K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 251 | $77K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 250 | $2.2M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 251 | $113K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 251 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.