| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SIMPLIFY INSURANCE LLC3 Filed as: SIMPLIFY BENEFITS INC | 605 PORTLAND AVE UNIT 531 GLADSTONE, OR 97027 | AFLAC | $10K | $0 | $10K | 11.40% |
| MICHAEL STASTNY3 | 605 PORTLAND AVE UNIT 531 GLADSTONE, OR 97027 | AFLAC | $3K | $396 | $3K | 3.46% |
| PAUL LANGAS3 | 700 N HAYDEN ISLAND DRIVE SUITE 220 PORTLAND, OR 97217 | AFLAC | $2K | $580 | $2K | 2.58% |
| VIRGINIA L KNOPSKI3 Filed as: VIRGINIA KNOPSKI | 17001 MILL LN LONG BEACH, WA 98631 | AFLAC | $181 | $79 | $260 | 0.31% |
| MATTHEW G BERGER3 Filed as: MATTHEW BUMALA | 37707 30TH PL S FEDERAL WAY, WA 98003 | AFLAC | $122 | $97 | $219 | 0.26% |
| IONNIS GRATSINOPOULOS3 | 3565 SUMMERLINN DR WEST LINN, OR 97068 | AFLAC | $60 | $79 | $139 | 0.16% |
| BRIAN L HUGGER3 Filed as: BRIAN HUGGER | 10117 SE SUNNYSIDE RD STE F52 CLACKAMAS, OR 97015 | AFLAC | $104 | $0 | $104 | 0.12% |
| DEREK SOMMERS3 | 518 N 39TH PL RIDGEFIELD, WA 98642 | AFLAC | $99 | $0 | $99 | 0.12% |
| MATTHEW G BERGER3 Filed as: MATTHEW SHROYER | 7407 N WILLIAMS AVE PORTLAND, OR 97217 | AFLAC | $83 | $0 | $83 | 0.10% |
| CAMERON CARRILLO3 | 22556 SW 96TH DR TUALATIN, OR 97062 | AFLAC | $76 | $0 | $76 | 0.09% |
| TERRY ANN PARKER3 Filed as: TERRY PARKER | 11175 SW BERLIN AVE WILSONVILLE, OR 97070 | AFLAC | $23 | $0 | $23 | 0.03% |
| VERENA NORTH3 | 17299 S NORTH END ROAD OREGON CITY, OR 97045 | AFLAC | $9 | $0 | $9 | 0.01% |
| LARRY A MORRIS3 Filed as: LARRY MORRIS | 259 S SEQUOIA PKWY #K093 CANBY, OR 97013 | AFLAC | $8 | $0 | $8 | 0.01% |
| ROLAND VALDES3 | 117 NE 150TH ST VANCOUVER, WA 98685 | AFLAC | $6 | $0 | $6 | 0.01% |
| CHRISTOPHER WALLACE HOFF3 Filed as: CHRISTOPHER HOFF | 1095 WILLOW BND ROSWELL, GA 30075 | AFLAC | $2 | $0 | $2 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FIRST CHOICE HEALTH ADMINISTRATORS EIN 91-1272766 NONE | Contract Administrator; Claims processing Service code 12 | 600 UNIVERSITY STREET, SUITE 1400 SEATTLE, WA 98101 | $112K |
| FIRST CHOICE HEALTH EMPLOYEE ASSIST EIN 91-1272766 NONE | Other services Service code 49 | 600 UNIVERSITY STREET, SUITE 1400 SEATTLE, WA 98101 | $7K |
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 | 494 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 494 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 494 | $300K |
| Life insurance | AFLAC | 109 | $85K |
| Short-term disability | AFLAC | 109 | $85K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 494 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.