| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62683 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $35 | $618 | $653 | 0.80% |
| WARD INSURANCE AGENCY INC3 | PO BOX 10167 EUGENE, OR 97440 | HARTFORD LIFE AND ACCIDENT | $5 | $0 | $5 | 0.01% |
| MARCI MARIE OTIS3 Filed as: MARCI M. OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | $0 | $1K | 2.78% |
| CAROL A. KENYON3 | 1641 CLEVELAND HILL ROAD ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $868 | $0 | $868 | 2.39% |
| MJ INSURANCE3 Filed as: JEREMY CILLEY & VARIOUS AGENTS | 1115 PEARL STREET EUGENE, OR 97401 | CONTINENTAL AMERICAN INSURANCE COMPANY | $231 | $0 | $231 | 0.64% |
| RICHARD E. SYFERT3 | PO BOX 2079 JASPER, OR 97438 | CONTINENTAL AMERICAN INSURANCE COMPANY | $188 | $0 | $188 | 0.52% |
| SHAWN M. OTIS3 | 200 JULINA LANE ROSEBURG, OR 97471 | CONTINENTAL AMERICAN INSURANCE COMPANY | $119 | $0 | $119 | 0.33% |
| CHRISTOPHER E. RUSSELL3 | 1895 WEST 17TH AVENUE EUGENE, OR 97402 | CONTINENTAL AMERICAN INSURANCE COMPANY | $114 | $0 | $114 | 0.31% |
| MARK D LUTHER3 Filed as: MARK D. LUTHER | 804 MOOREFIELD PARK DRIVE SUITE 106 RICHMOND, VA 23236 | CONTINENTAL AMERICAN INSURANCE COMPANY | $113 | $0 | $113 | 0.31% |
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 | 251 | 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) | 251 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 401 | $2.6M |
| Dental(2 contracts, 2 carriers) | PACIFICSOURCE HEALTH PLANS | 401 | $2.7M |
| Vision | PACIFICSOURCE HEALTH PLANS | 401 | $2.6M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 254 | $82K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 254 | $82K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 254 | $82K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 401 | $2.6M |
| Other(4 contracts, 4 carriers) | HARTFORD LIFE AND ACCIDENT | 268 | $201K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 401 | — |
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.
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.