| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PACIFIC BENEFIT CONSULTANTS3 Filed as: PACIFIC BENEFIT CONSULTANTS, INC. | 450 COUNTRY CLUB RD, STE 330 EUGENE, OR 97401 | PROVIDENCE HEALTH PLAN | $33K | — | $33K | 3.00% |
| PACIFIC BENEFIT CONSULTANTS3 Filed as: PACIFIC BENEFIT CONSULTANTS, INC. | SUITE 330, 450 COUNTRY CLUB ROAD EUGENE, OR 97401 | KANSAS CITY LIFE INSURANCE COMPANY | $10K | — | $10K | 8.45% |
| PACIFIC BENEFIT CONSULTANTS3 | 450 COUNTRY CLUB RD, STE 330 EUGENE, OR 97401 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 8.85% |
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 | 205 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 205 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 205 | $1.1M |
| Dental | KANSAS CITY LIFE INSURANCE COMPANY | 146 | $113K |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 119 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 205 | — |
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.