| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJI, INC. DBA HAGAN HAMILTON INSURA | PO BOX 847 MCMINNVILLE, OR 97218 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $32K | $1K | $33K | 1.33% |
| ELIZABETH BLACK3 Filed as: ELIZABETH R BLACK | PO BOX 847 MCMINNVILLE, OR 97128 | PACIFICSOURCE HEALTH PLANS | $26K | — | $26K | 1.15% |
| DAWN MILLER3 | PO BOX 847 MCMINNVILLE, OR 97128 | PACIFICSOURCE HEALTH PLANS | $26K | — | $26K | 1.15% |
| MJ INSURANCE3 Filed as: MJI INC DBA HAGAN HAMILTON INSURANC | PO BOX 847 MCMINNVILLE, OR 97128 | PRINCIPAL LIFE INSURANCE COMPANY | $19K | $9K | $28K | 11.50% |
| MJ INSURANCE3 Filed as: MJI, INC. DBA HAGAN-HAMILTON INSURA | — | WILLAMETTE DENTAL INSURANCE, INC. | $4K | — | $4K | 5.00% |
| MJ INSURANCE3 Filed as: MJI, INC DBA HAGAN HAMILTON INSURAN | PO BOX 847 MCMINNVILLE, OR 97128 | VISION SERVICE PLAN | $2K | — | $2K | 4.19% |
| SHEREEN EMDE3 | 6449 HIGHWAY 219 NORTHEAST GERVAIS, OR 97026 | AFLAC | $262 | $70 | $332 | 3.35% |
| PAUL FRAMPTON3 | 3616 GRAND OAK DRIVE NEWBERG, OR 97132 | AFLAC | $151 | — | $151 | 1.52% |
| MELISSA HOLLENBECK3 | 493 WEST FIR STREET STAYTON, OR 97383 | AFLAC | $81 | $13 | $94 | 0.95% |
| WILLIAM R MEDITZ3 Filed as: WILLIAM MEDITZ | 25884 SOUTHWEST CANYON CREEK ROAD APARTMENT J202 WILSONVILLE, OR 97070 | AFLAC | $70 | — | $70 | 0.71% |
| SHARON DOUGLASS3 | 702 PATROL STREET MOLALLA, OR 97038 | AFLAC | $63 | — | $63 | 0.64% |
| BRAD P CHEWNING3 Filed as: BRAD CHEWNING | 26000 HALL ROAD WILLAMINA, OR 97396 | AFLAC | $58 | — | $58 | 0.59% |
| TREVOR WILKS3 | 722 HIGHLAND AVENUE NORTHEAST SALEM, OR 97301 | AFLAC | $38 | $14 | $52 | 0.52% |
| VINCENT BRIAN VOLLMAR3 Filed as: VINCENT VOLLMAR | 3295 TRIANGLE DRIVE SOUTHEAST SUITE 120 SALEM, OR 97302 | AFLAC | $32 | $17 | $49 | 0.49% |
| ALICIA J MATSON3 Filed as: ALICIA MATSON | 6027 ROLLETTI DRIVE SOUTHEAST SALEM, OR 97306 | AFLAC | $47 | — | $47 | 0.47% |
| NICHOLAS JENSEN3 | 6175 SKYLINE DRIVE WEST LINN, OR 97068 | AFLAC | $44 | — | $44 | 0.44% |
| SCOTT NIELSEN3 | 2709 DAY ISLAND BOULEVARD WEST UNIT A UNIVERSITY PLACE, WA 98466 | AFLAC | $36 | — | $36 | 0.36% |
| SHANE HUNTER3 | 708 BROWNING AVENUE SOUTH APARTMENT 14 SALEM, OR 97302 | AFLAC | $23 | $3 | $26 | 0.26% |
| TERRIE RUNOLFSON3 | PO BOX 1959 COTTONWOOD, CA 96022 | AFLAC | $20 | — | $20 | 0.20% |
| KENNETH MAGEE3 | 3760 MARKET STREET NORTHEAST 347 SALEM, OR 97301 | AFLAC | $17 | — | $17 | 0.17% |
| LARRI B WHEELER3 | 81640 LOST VALLEY LANE DEXTER, OR 97431 | AFLAC | $16 | — | $16 | 0.16% |
| ROBERT ALLEN WHEELER3 Filed as: ROBERT WHEELER | 645 NORTHWEST EVE DRIVE DALLAS, OR 97338 | AFLAC | $15 | — | $15 | 0.15% |
| JEFFORY MERTEN3 | 906 NORTHWEST LEWISBURG AVENUE CORVALLIS, OR 97330 | AFLAC | $13 | — | $13 | 0.13% |
| MJ INSURANCE3 Filed as: MJI INC DBA HAGAN | PO BOX 847 MCMINNVILLE, OR 97128 | AFLAC | $10 | — | $10 | 0.10% |
| ORVILLE DELKER3 | 3001 SUNNY HILL CIRCLE RAPID CITY, SD 57702 | AFLAC | $10 | — | $10 | 0.10% |
| PAUL HANNANT3 | 6052 SAWGRASS STREET SOUTHEAST SALEM, OR 97306 | AFLAC | $8 | — | $8 | 0.08% |
| BRET L RUNOLFSON3 Filed as: BRET RUNOLFSON | 2105 FOREST AVENUE SUITE 110 CHICO, CA 95928 | AFLAC | $8 | — | $8 | 0.08% |
| NOLA EVANS INC3 Filed as: NOLA EVANS | 10853 SOUTH RIDGE TOP DRIVE MOLALLA, OR 97038 | AFLAC | $8 | — | $8 | 0.08% |
| MARCI MARIE OTIS3 Filed as: MARCI OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $7 | — | $7 | 0.07% |
| BARRY T FISHER3 | 9662 SPRINGMEADOW DRIVE NEW PORT RICHEY, FL 34655 | AFLAC | $5 | — | $5 | 0.05% |
| GINA SIENIA3 | PO BOX 446 ECHO, OR 97826 | AFLAC | $3 | — | $3 | 0.03% |
| ERNEST E SNOOK3 Filed as: ERNEST SNOOK | 14011 282ND LANE NORTHEAST DUVALL, WA 98019 | AFLAC | $3 | — | $3 | 0.03% |
| ERIC DANIEL WEILAND3 Filed as: ERIC WEILAND | 14511 SOUTHWEST CORNERSTONE LANE SHERWOOD, OR 97140 | AFLAC | $3 | — | $3 | 0.03% |
| JOSHUA ANDERSON3 | 1341 NORTH 16TH STREET MONMOUTH, OR 97361 | AFLAC | $2 | — | $2 | 0.02% |
| DEE TOGIKAWA3 | 3060 WESTVIEW COURT LAKE OSWEGO, OR 97034 | AFLAC | $2 | — | $2 | 0.02% |
| ARDELL SMITH3 | 4334 NORTHWEST CHANTICLEAR DRIVE APARTMENT N-5 PORTLAND, OR 97229 | AFLAC | $2 | — | $2 | 0.02% |
| IOANNIS T GRATSINOPOULOS3 Filed as: IOANNIS GRATSINOPOULOS | 3565 SUMMERLINN DRIVE WEST LINN, OR 97068 | AFLAC | $1 | — | $1 | 0.01% |
| SHANE EDMUND ATTEBERY3 Filed as: SHANE ATTEBERY | 391 RANDY DRIVE GRANTS PASS, OH 97527 | AFLAC | $1 | — | $1 | 0.01% |
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 | 414 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 418 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 373 | $4.8M |
| Dental | WILLAMETTE DENTAL INSURANCE, INC. | 95 | $75K |
| Vision | VISION SERVICE PLAN | 383 | $38K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 414 | $243K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 414 | $243K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 414 | $243K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 414 | $253K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 414 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.