| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | PROVIDENCE HEALTH PLAN | $27K | $0 | $27K | 2.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 749083 LOS ANGELES, CA 90074 | STANDARD INSURANCE COMPANY | $5K | $1K | $7K | 7.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | STANDARD INSURANCE COMPANY | $0 | $2K | $2K | 1.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NE LIMITED | 1065 AVENUE OF THE AMERICAS NEW YORK, NY 10018 | STANDARD INSURANCE COMPANY | $0 | $366 | $366 | 0.39% |
| ANDREW N LUCCOCK3 | 19766 WILDWOOD DRIVE WEST LINN, OR 97068 | AFLAC | $1K | $94 | $1K | 9.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 6443 SW BEAVERTON HILLSDALE HWY SUITE 200 PORTLAND, OR 97221 | AFLAC | $727 | $0 | $727 | 4.87% |
| MJ INSURANCE3 Filed as: DAVID L JENKINS AND VARIOUS AGENTS | 10340 SOUTHWEST GREENLEAF TERRACE PORTLAND, OR 97224 | AFLAC | $400 | $0 | $400 | 2.68% |
| BRYAN G CORBIN LLC3 | 17 WESTRIDGE DRIVE LAKE OSWEGO, OR 97034 | AFLAC | $206 | $0 | $206 | 1.38% |
| BRIDGET RENEA TOWNSEND3 | 28317 SOUTHWEST PARIS AVENUE WILSONVILLE, OR 97070 | AFLAC | $127 | $19 | $146 | 0.98% |
| TERESA MAUREEN CRAVINHO3 | 9395 SOUTHWEST SIUSLAW LANE TUALATIN, OR 97062 | AFLAC | $87 | $0 | $87 | 0.58% |
| LORENA FAY NAKAGAWA3 | 6152 NORTHEAST BRIGHTON STREET HILLSBORO, OR 97124 | AFLAC | $70 | $0 | $70 | 0.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 12100 NORTHEAST 195TH STREET BOTHELL, WA 98011 | CONTINENTAL AMERICAN INSURANCE COMPANY | $154 | $0 | $154 | 3.39% |
| JIM B CORNETT3 | 4702 SOUTHWEST VOLCANO AVENUE REDMOND, OR 97756 | CONTINENTAL AMERICAN INSURANCE COMPANY | $20 | $0 | $20 | 0.44% |
| CAMERON CARRILLO3 | 22556 SOUTHWEST 96TH DRIVE TUALATIN, OR 97062 | CONTINENTAL AMERICAN INSURANCE COMPANY | $16 | $0 | $16 | 0.35% |
| HAILEY BAGGETT3 Filed as: HAILEY N PARKER | 15320 ARBORVIE WEST COURT ORANGE CITY, OR 97045 | CONTINENTAL AMERICAN INSURANCE COMPANY | $13 | $0 | $13 | 0.29% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH WILLIS JR AND VARIOUS AGENTS | 10351 NORTHEAST 10TH STREET SUITE 1714 BELLEVUE, WA 98004 | CONTINENTAL AMERICAN INSURANCE COMPANY | $13 | $0 | $13 | 0.29% |
| ERIC F CORNETT3 | 19482 HOLLYGRAPE STREET BEND, OR 97702 | CONTINENTAL AMERICAN INSURANCE COMPANY | $12 | $0 | $12 | 0.26% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 1089 LAKE WASHINGTON BOULEVARD SUITE 306 RENTON, WA 98056 | CONTINENTAL AMERICAN INSURANCE COMPANY | $12 | $0 | $12 | 0.26% |
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 | 105 | 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) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 98 | $895K |
| Dental(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 105 | $98K |
| Vision | PROVIDENCE HEALTH PLAN | 98 | $895K |
| Life insurance | STANDARD INSURANCE COMPANY | 105 | $93K |
| Short-term disability | AFLAC | 24 | $15K |
| Long-term disability | STANDARD INSURANCE COMPANY | 105 | $93K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 98 | $895K |
| Other(3 contracts, 3 carriers) | STANDARD INSURANCE COMPANY | 105 | $113K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 105 | — |
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.