| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC. | PO BOX 29 SPRINGFIELD, OR 97477 | PACIFICSOURCE HEALTH PLAN | $30K | $0 | $30K | 2.57% |
| UNKNOWN3 | UNKNOWN BEND, OR 97701 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $3K | $0 | $3K | 2.73% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC. | PO BOX 784 SPRINGFIELD, OR 97477 | LIFEMAP ASSURANCE COMPANY | $5K | $0 | $5K | 11.86% |
| GREGORY SCOTT GANNON3 | 19639 EMERALD PLACE BEND, OR 97702 | AFLAC | $624 | $0 | $624 | 3.29% |
| PHILIP GREGORY HETZ3 | PO BOX 6166 BEND, OR 97708 | AFLAC | $445 | $116 | $561 | 2.96% |
| PHILIP GREGORY HETZ3 | 19871 PORCUPINE DRIVE BEND, OR 97702 | AFLAC | $429 | $0 | $429 | 2.26% |
| MJ INSURANCE3 Filed as: SCOTT E. NIELSEN AND VARIOUS AGENTS | 1089 LAKE WASHINGTON BOULEVARD N. APARTMENT 306 RENTON, WA 98056 | AFLAC | $427 | $0 | $427 | 2.25% |
| GUY R SOUTER3 Filed as: GUY R. SOUTER | 16280 PINE DROP LANE LA PINE, OR 97739 | AFLAC | $281 | $46 | $327 | 1.72% |
| SCOTT ROBERT STORJOHANN3 | 10701 MELODY DRIVE, SUITE 500 NORTHGLENN, CO 80234 | AFLAC | $129 | $0 | $129 | 0.68% |
| DIXIE D SIMON3 Filed as: DIXIE D. SIMON | 509 NORTH SHAMROCK ROAD SPOKANE VALLEY, WA 99037 | AFLAC | $102 | $0 | $102 | 0.54% |
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 | 115 | 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) | 115 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLAN | 239 | $1.2M |
| Dental | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 259 | $107K |
| Vision | PACIFICSOURCE HEALTH PLAN | 239 | $1.2M |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 127 | $46K |
| Short-term disability(2 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 127 | $65K |
| Long-term disability | LIFEMAP ASSURANCE COMPANY | 127 | $46K |
| Prescription drug | PACIFICSOURCE HEALTH PLAN | 239 | $1.2M |
| Other(2 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 127 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 259 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.