| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF, SEIBELS AND WILLIAMS, INC. | 1800 SW FIRST AVENUE, SUITE 400 PORTLAND, OR 97201 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $46K | — | $46K | 2.71% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 12100 NE 195TH STREET, SUITE 200 BOTHELL, WA 98041 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $22K | — | $22K | 1.31% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF, SEIBELS AND WILLIAMS, INC. | 1800 SW 1ST AVENUE, SUITE 400 PORTLAND, OR 97201 | AETNA LIFE INSURANCE COMPANY | $4K | $113 | $4K | 2.72% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 415 NORTH 2ND STREET YAKIMA, WA 98901 | AETNA LIFE INSURANCE COMPANY | $2K | — | $2K | 1.04% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF, SEIBELS AND WILLIAMS, INC. | 1800 SW FIRST AVENUE, SUITE 400 PORTLAND, OR 97201 | HARTFORD LIFE AND ACCIDENT | $6K | — | $6K | 9.79% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 12100 NE 195TH STREET, SUITE 200 BOTHELL, WA 98011 | HARTFORD LIFE AND ACCIDENT | $3K | — | $3K | 5.21% |
| BB&T INSURANCE SERVICES, INC.3 Filed as: BB AND T INSURANCE SERVICES, INC. | 414 GALLIMORE DAIRY ROAD, SUITE F GREENSBORO, NC 27409 | HARTFORD LIFE AND ACCIDENT | — | $1K | $1K | 1.90% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 749083 LOS ANGELES, CA 90074 | VISION SERVICE PLAN | $316 | — | $316 | 1.48% |
| PAUL LANGAS3 | 700 NORTH HAYDEN ISLAND DRIVE SUITE 220 PORTLAND, OR 97217 | AFLAC | $4K | $495 | $5K | 22.74% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF, SEIBELS AND WILLIAMS, INC. | 816 TOWN AND COUNTRY BOULEVARD SUITE 500 HOUSTON, TX 77024 | AFLAC | $1K | — | $1K | 6.04% |
| MATHEW A. BUMALA3 | 14415 NW 25TH COURT VANCOUVER, WA 98685 | AFLAC | $603 | $3 | $606 | 2.93% |
| MICHAEL C WALKER3 Filed as: MICHAEL L. ALLEY | 5200 MEADOWS ROAD, SUITE 150 LAKE OSWEGO, OR 97035 | AFLAC | $181 | $84 | $265 | 1.28% |
| CHRISTOPHER WALLACE HOFF3 | 121 ROCKY POINT COURT ACWORTH, GA 30101 | AFLAC | $87 | $84 | $171 | 0.83% |
| VERENA NORTH3 | 700 NORTH HAYDEN ISLAND DRIVE SUITE 200 PORTLAND, OR 97217 | AFLAC | $16 | $25 | $41 | 0.20% |
| KEVIN C DUNN4 Filed as: KEVIN DUNN | 4120 NORTH FERDINAND STREET TACOMA, WA 98407 | PRE-PAID LEGAL SERIVCES, INC. DBA LEGALSHIELD | $2K | — | $2K | 46.12% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF, SEIBELS AND WILLIAMS, INC. | 1800 SW FIRST AVENUE, SUITE 400 PORTLAND, OR 97201 | PRE-PAID LEGAL SERIVCES, INC. DBA LEGALSHIELD | $36 | — | $36 | 0.70% |
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 | 387 | 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) | 387 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 387 | $1.7M |
| Dental | AETNA LIFE INSURANCE COMPANY | 407 | $162K |
| Vision | VISION SERVICE PLAN | 183 | $21K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 235 | $58K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 235 | $58K |
| Prescription drug | REGENCE BLUECROSS BLUESHIELD OF OREGON | 387 | $1.7M |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 235 | $84K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 407 | — |
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.