| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $22K | $0 | $22K | 1.30% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 700 NE MULTNOMAH STREET, SUITE 1300 PORTLAND, OR 97232 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $51 | $4K | 3.54% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $56 | $56 | 0.05% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 8.04% |
| KAREN CLAY KUNKLER3 Filed as: KAREN CLAY KUNKLER AND OTHER AGENTS | 1709 NW 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $314 | $19 | $333 | 5.12% |
| HEARTSEASE LLC3 Filed as: HEARTSEASE, LLC | 1521 NE 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $246 | $48 | $294 | 4.52% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $69 | $11 | $80 | 1.23% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $66 | $10 | $76 | 1.17% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $42 | $0 | $42 | 0.65% |
| SUSAN J LEACH3 Filed as: SUSAN J. LEACH | 4419 NE 131ST PLACE PORTLAND, OR 97230 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.11% |
| TIMOTHY J REED3 Filed as: TIMOTHY J. REED | 21 AZALEA DRIVE LUMBERTON, NJ 08048 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.06% |
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 | 421 | 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) | 421 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 193 | $1.7M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 322 | $111K |
| Vision | REGENCE BLUECROSS BLUESHIELD OF OREGON | 193 | $1.7M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 421 | $27K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 421 | $27K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 421 | $27K |
| Prescription drug | REGENCE BLUECROSS BLUESHIELD OF OREGON | 193 | $1.7M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 421 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 421 | — |
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.