| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANDREW N LUCCOCK3 | PO BOX 1965 WILSONVILLE, OR 97070 | AFLAC | $975 | $75 | $1K | 9.07% |
| DDI BENEFITS INC.3 Filed as: DDI BENEFITS | 13435 NE WHITAKER WAY PORTLAND, OR 97230 | AFLAC | $461 | $0 | $461 | 3.98% |
| BRIAN L HUGGER3 | 14825 SE 119TH AVE CLACKAMAS, OR 97015 | AFLAC | $123 | $15 | $138 | 1.19% |
| BRIDGET RENEA TOWNSEND3 | 15060 SE BARKLEY CT. DAMASCUS, OR 97089 | AFLAC | $98 | $0 | $98 | 0.85% |
| TY ROBERT NAUGLE3 | 4875 SW 195TH CT ALOHA, OR 97078 | AFLAC | $43 | $15 | $58 | 0.50% |
| SHARON DOUGLASS3 Filed as: SHARON C DOUGLASS | 702 PATROL STREET MOLALLA, OR 97038 | AFLAC | $54 | $0 | $54 | 0.47% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 1089 LAKE WASHINGTON BLVD N APT. 306 RENTON, WA 98056 | AFLAC | $33 | $0 | $33 | 0.29% |
| CHRISTOPHER WALLACE HOFF3 | 5665 MEADOWS RD SUITE 140 LAKE OSWEGO, OR 97035 | AFLAC | $17 | $15 | $32 | 0.28% |
| RUSSELL HONDA3 Filed as: RUSSELL K HONDA | 21932 SW CREEK DR TUALATIN, OR 97062 | AFLAC | $18 | $0 | $18 | 0.16% |
| NOLA EVANS INC3 Filed as: NOLA EVANS INC. | 1111 N PONDEROSA STREET CANBY, OR 97013 | AFLAC | $15 | $0 | $15 | 0.13% |
| AHMAD GHODS3 | 20048 SW 56TH AVE TUALATIN, OR 97062 | AFLAC | $15 | $0 | $15 | 0.13% |
| LARRY SHERWOOD & ASSOCIATES INC3 Filed as: LARRY SHERWOOD & ASSOCIATES INC. | 10220 SW GREENBURG ROAD SUITE 225 PORTLAND, OR 97223 | AFLAC | $13 | $0 | $13 | 0.11% |
| PEGGY JO JENNEN3 | 320 PIN OAK DR OREGON CITY, OR 97045 | AFLAC | $12 | $0 | $12 | 0.10% |
| JERRY OLIVER CREECH3 | 233 MIDDLE STREET SUITE 214 NEW BERN, NC 28560 | AFLAC | $12 | $0 | $12 | 0.10% |
| ANDRE PRINCE LOVINGIER3 | 1817 BLOYD STREET KELSO, WA 98626 | AFLAC | $9 | $0 | $9 | 0.08% |
| DARL CORNMAN3 | 18399 SW 133RD TERRACE TUALATIN, OR 97062 | AFLAC | $8 | $0 | $8 | 0.07% |
| KEVIN B SORIA3 | 815 S BRIDGE WAY PL SUITE 100 EAGLE, ID 83616 | AFLAC | $8 | $0 | $8 | 0.07% |
| BRYAN JORAMO3 | 2606 STRASBURG DR FOREST GROVE, OR 97116 | AFLAC | $7 | $0 | $7 | 0.06% |
| ZINA SHADRIN3 | 10200 SW GREENBURG RD SUITE 320 PORTLAND, OR 97223 | AFLAC | $4 | $0 | $4 | 0.03% |
| NICHOLAS JENSEN3 Filed as: NICHOLAS C JENSEN | 4965 SW SWAUM WAY TUALATIN, OR 97062 | AFLAC | $4 | $0 | $4 | 0.03% |
| JEROMY E. CILLEY3 Filed as: JEROMY E CILLEY | 2396 HAWKINS LN EUGENE, OR 97405 | AFLAC | $4 | $0 | $4 | 0.03% |
| RITA J ROBINSON3 | 21780 WILLAMETTE DR SUITE BWEST WEST LINN, OR 97068 | AFLAC | $4 | $0 | $4 | 0.03% |
| DALE ALLEN NICHOLS3 | 728 LEGENDS CREST DRIVE FRANKLIN, TN 37069 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $71 | $0 | $71 | 2.73% |
| LEONARD ADAMS INSURANCE INC3 Filed as: LEONARD ADAMS INSURANCE INC. | 5201 SW WESTGATE DR. SUITE 300 PORTLAND, OR 37069 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $63 | $0 | $63 | 2.42% |
| DDI BENEFITS INC.3 Filed as: DDI BENEFITS | PO BOX 13090 PORTLAND, OR 97213 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6 | $0 | $6 | 0.23% |
| SUE B MARTINES4 Filed as: SUE B. MARTINES | 1665 NW HIGHLAND DR CORVALLIS, OR 97330 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $138 | $0 | $138 | 32.78% |
| CURTIS A. ALMQUIST4 | 301 S. JAMES STREET SILVERTON, OR 97381 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $48 | $0 | $48 | 11.40% |
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 | 130 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 135 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 355 | $1.3M |
| Dental | STANDARD INSURANCE COMPANY | 139 | $168K |
| Vision | PROVIDENCE HEALTH PLAN | 355 | $1.3M |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 134 | $34K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 91 | $21K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 91 | $21K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 355 | $1.3M |
| Other(5 contracts, 5 carriers) | AFLAC | 155 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 355 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.