| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 6979 SOUTHEAST LAKE ROAD PORTLAND, OR 97267 | PROVIDENCE HEALTH PLAN | $34K | $0 | $34K | 2.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NE LIMITED | 1065 AVENUE OF THE AMERICAS NEW YORK, NY 10018 | STANDARD INSURANCE COMPANY | $0 | $10K | $10K | 12.56% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NW LLC | PO BOX 749083 LOS ANGELES, CA 90074 | STANDARD INSURANCE COMPANY | $2K | $0 | $2K | 2.79% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 6443 SW BEAVERTON HILLSDALE HIGHWAY SUITE 200 PORTLAND, OR 97221 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $0 | $4K | 10.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 501 SOUTH BERNARD, SUITE 200 SPOKANE, WA 99204 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $1K | $1K | 3.48% |
| ANDREW N LUCCOCK3 | PO BOX 1965 WILSONVILLE, OR 97070 | AFLAC | $2K | $245 | $2K | 8.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 6443 SW BEAVERTON HILLSDALE HWY SUITE 200 PORTLAND, OR 97221 | AFLAC | $976 | $0 | $976 | 4.57% |
| TERESA MAUREEN CRAVINHO3 Filed as: TERESA MAUREEN CRAVINHO AND AGENTS | 9395 SOUTHWEST SIUSLAW LANE TUALATIN, OR 97062 | AFLAC | $759 | $46 | $805 | 3.77% |
| BRIDGET RENEA TOWNSEND3 | 3635 5TH STREET HUBBARD, OR 97032 | AFLAC | $443 | $80 | $523 | 2.45% |
| KAREN MCKAY3 | 8288 SOUTHWEST LAFAYETTE WAY WILSONVILLE, OR 97070 | AFLAC | $151 | $70 | $221 | 1.04% |
| VIRGINIA L KNOPSKI3 | 17001 MILL LANE LONG BEACH, WA 98631 | AFLAC | $135 | $68 | $203 | 0.95% |
| LORENA FAY NAKAGAWA3 | 6152 NORTHEAST BRIGHTON STREET HILLSBORO, OR 97124 | AFLAC | $136 | $0 | $136 | 0.64% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 12100 NORTHEAST 195TH STREET SUITE 200 BOTHELL, WA 98011 | CONTINENTAL AMERICAN INSURANCE COMPANY | $406 | $0 | $406 | 5.33% |
| JIM B CORNETT3 | 4702 SOUTHWEST VOLCANO AVENUE REDMOND, OR 97756 | CONTINENTAL AMERICAN INSURANCE COMPANY | $56 | $0 | $56 | 0.73% |
| CAMERON CARRILLO3 | 22556 SOUTHWEST 96TH DRIVE TUALATIN, OR 97062 | CONTINENTAL AMERICAN INSURANCE COMPANY | $42 | $0 | $42 | 0.55% |
| ERIC F CORNETT3 | 19482 HOLLYGRAPE STREET BEND, OR 97702 | CONTINENTAL AMERICAN INSURANCE COMPANY | $36 | $0 | $36 | 0.47% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH H WILLIS JR AND OTHER AGENTS | 10351 NORTHEAST 10TH STREET SUITE 1714 BELLEVUE, WA 98004 | CONTINENTAL AMERICAN INSURANCE COMPANY | $36 | $0 | $36 | 0.47% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 1089 LAKE WASHINGTON BOULEVARD N SUITE 306 RENTON, WA 98056 | CONTINENTAL AMERICAN INSURANCE COMPANY | $32 | $0 | $32 | 0.42% |
| HAILEY BAGGETT3 Filed as: HAILEY N PARKER | 15320 ARBORVIE WEST COURT OREGON CITY, OR 97045 | CONTINENTAL AMERICAN INSURANCE COMPANY | $29 | $0 | $29 | 0.38% |
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 | 169 | 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) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 201 | $1.1M |
| Dental(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 137 | $87K |
| Vision | PROVIDENCE HEALTH PLAN | 201 | $1.1M |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 169 | $35K |
| Short-term disability | AFLAC | 37 | $21K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 169 | $35K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 201 | $1.1M |
| Other(3 contracts, 3 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 169 | $64K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 201 | — |
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.