| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | MODA HEALTH | $47K | $0 | $47K | 3.02% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $3K | $0 | $3K | 3.42% |
| ADP INC5 Filed as: AUTOMATIC DATA PROCESSING, INC. | PO BOX 842875 BOSTON, MA 02284 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $12K | $12K | 18.85% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $3K | $9K | 13.97% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | PO BOX 4386 MISSOULA, MT 59806 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $131 | $1 | $132 | 9.17% |
| WORKSITE BENEFITS GROUP INC3 Filed as: WORKSITE BENEFITS GROUP AND AGENTS | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $54 | $32 | $86 | 5.98% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $17 | $43 | 2.99% |
| RAQUEL LOSADA MONROY3 | 817 NE DELP ROAD CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | $6 | $42 | 2.92% |
| MARCI TALBURT3 | 4721 AZALEA GLEN ROAD GLENDALE, OR 97442 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | $4 | $26 | 1.81% |
| MELISSA CATHLEEN HADLOCK3 | 14912 NE 249TH STREET BATTLE GROUND, WA 98604 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | $2 | $23 | 1.60% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | $0 | $23 | 1.60% |
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 | 258 | 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) | 258 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MODA HEALTH | 137 | $1.6M |
| Dental | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 191 | $101K |
| Vision | MODA HEALTH | 137 | $1.6M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 111 | $64K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 111 | $64K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 111 | $64K |
| Prescription drug | MODA HEALTH | 137 | $1.6M |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 258 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 258 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.