| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE | PO BOX 29 SPRINGFIELD, OR 97477 | PROVIDENCE HEALTH PLAN | $28K | $0 | $28K | 3.06% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE | PO BOX 784 SPRINGFIELD, OR 97477 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | $494 | $8K | 8.14% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE | PO BOX 29 SPRINGFIELD, OR 97577 | WILLAMETTE DENTAL INSURANCE, INC. | $614 | $0 | $614 | 4.00% |
| PHILIP GREGORY HETZ3 Filed as: PHILIP HETZ | 19871 PORCUPINE DRIVE BEND, OR 97702 | AFLAC | $1K | $0 | $1K | 9.25% |
| DOREEN HETZ3 | 19871 PORCUPINE DRIVE BEND, OR 97702 | AFLAC | $368 | $56 | $424 | 3.76% |
| GUY R SOUTER3 Filed as: GUY SOUTER | 16280 PINE DROP LANE LA PINE, OR 97739 | AFLAC | $378 | $16 | $394 | 3.50% |
| MJ INSURANCE3 Filed as: CHARLES ENDICOTT AND VARIOUS AGENTS | 1188 NE 27TH STREET, UNIT 46 BEND, OR 97701 | AFLAC | $221 | $0 | $221 | 1.96% |
| JEAN CONGLETON3 | 21143 BEE TREE LANE BEND, OR 97701 | AFLAC | $186 | $0 | $186 | 1.65% |
| RICHARD J ROSS3 Filed as: RICHARD ROSS | 2463 NE BUCKWHEAT COURT BEND, OR 97701 | AFLAC | $100 | $6 | $106 | 0.94% |
| DIXIE D SIMON3 Filed as: DIXIE SIMON | 509 NORTH SHAMROCK ROAD SPOKANE VALLEY, WA 99037 | AFLAC | $75 | $0 | $75 | 0.67% |
| DOREEN HETZ3 | 19871 PORCUPINE DRIVE BEND, OR 97702 | AFLAC | $387 | $41 | $428 | 4.84% |
| PHILIP GREGORY HETZ3 Filed as: PHILIP HETZ | 19871 PORCUPINE DRIVE BEND, OR 97702 | AFLAC | $265 | $45 | $310 | 3.50% |
| GUY R SOUTER3 Filed as: GUY SOUTER | 16280 PINE DROP LANE LA PINE, OR 97739 | AFLAC | $222 | $34 | $256 | 2.89% |
| JEAN CONGLETON3 | 21143 BEE TREE LANE BEND, OR 97701 | AFLAC | $207 | $0 | $207 | 2.34% |
| MJ INSURANCE3 Filed as: ROGER OLSON AND VARIOUS AGENTS | 471 DAVIS LAKE ROAD USK, WA 99180 | AFLAC | $153 | $0 | $153 | 1.73% |
| CHARLES N. ENDICOTT3 Filed as: CHARLES ENDICOTT | 1188 NE 27TH STREET, UNIT 46 BEND, OR 97701 | AFLAC | $104 | $0 | $104 | 1.18% |
| RICHARD J ROSS3 Filed as: RICHARD ROSS | 2463 NE BUCKWHEAT COURT BEND, OR 97701 | AFLAC | $60 | $0 | $60 | 0.68% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 159 | $913K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 168 | $110K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 168 | $95K |
| Life insurance(3 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 168 | $115K |
| Short-term disability(2 contracts) | AFLAC | 18 | $20K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 159 | $913K |
| Other(3 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 168 | $115K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 168 | — |
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.