| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC. | PO BOX 29 SPRINGFIELD, OR 97477 | PROVIDENCE HEALTH PLAN | $34K | $0 | $34K | 3.45% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC. | PO BOX 784 SPRINGFIELD, OR 97477 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | $423 | $8K | 8.35% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC. | PO BOX 784 SPRINGFIELD, OR 97477 | WILLAMETTE DENTAL INSURANCE, INC. | $933 | $0 | $933 | 4.00% |
| RYAN GEORGE KRUIT3 | 612 SE GLENEDEN PLACE BEND, OR 97702 | AFLAC | $1K | $46 | $1K | 6.71% |
| PHILLIP GREGORY HETZ3 | 19871 PORCUPINE DRIVE BEND, OR 97702 | AFLAC | $896 | $49 | $945 | 5.90% |
| MJ INSURANCE3 Filed as: DIXIE D. SIMON AND VARIOUS AGENTS | 509 NORTH SHAMROCK ROAD SPOKANE VALLEY, WA 99037 | AFLAC | $296 | $10 | $306 | 1.91% |
| DOREEN HETZ3 Filed as: DOREEN W. HETZ | 19871 PORCUPINE DRIVE BEND, OR 97702 | AFLAC | $275 | $0 | $275 | 1.72% |
| GUY R SOUTER3 Filed as: GUY R. SOUTER | PO BOX 1283 LA PINE, OR 97739 | AFLAC | $189 | $8 | $197 | 1.23% |
| JEAN CONGLETON3 | 21143 BEE TREE LANE BEND, OR 97701 | AFLAC | $175 | $0 | $175 | 1.09% |
| RICHARD J ROSS3 Filed as: RICHARD J. ROSS | 2463 NE BUCKWHEAT COURT BEND, OR 97701 | AFLAC | $94 | $0 | $94 | 0.59% |
| CHARLES N. ENDICOTT3 | 1188 NE 27TH STREET, UNIT 46 BEND, OR 97701 | AFLAC | $272 | $0 | $272 | 3.42% |
| JEAN CONGLETON3 | 21143 BEE TREE LANE BEND, OR 97701 | AFLAC | $207 | $0 | $207 | 2.60% |
| MJ INSURANCE3 Filed as: ROGER L. OLSON AND VARIOUS AGENTS | 471 DAVIS LAKE ROAD USK, WA 99180 | AFLAC | $160 | $0 | $160 | 2.01% |
| DOREEN HETZ3 Filed as: DOREEN W. HETZ | 19871 PORCUPINE DRIVE BEND, OR 97702 | AFLAC | $150 | $0 | $150 | 1.88% |
| GUY R SOUTER3 Filed as: GUY R. SOUTER | PO BOX 1283 LA PINE, OR 97739 | AFLAC | $120 | $0 | $120 | 1.51% |
| PHILLIP GREGORY HETZ3 | 19871 PORCUPINE DRIVE BEND, OR 97702 | AFLAC | $109 | $0 | $109 | 1.37% |
| RYAN GEORGE KRUIT3 | 612 SE GLENEDEN PLACE BEND, OR 97702 | AFLAC | $55 | $0 | $55 | 0.69% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KPD INSURANCE INC. | PO BOX 784 SPRINGFIELD, OR 97477 | BENEFIT INTELLIGENCE | $244 | $0 | $244 | 4.97% |
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 | 110 | 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) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | PROVIDENCE HEALTH PLAN | 164 | $991K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 185 | $121K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 185 | $97K |
| Life insurance(3 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 185 | $121K |
| Short-term disability(2 contracts) | AFLAC | 17 | $24K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 164 | $986K |
| Other(4 contracts, 3 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 185 | $126K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 185 | — |
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.