| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANDREW N LUCCOCK3 | PO BOX 1965 WILSONVILLE, OR 97070 | CONTINENTAL AMERICAN INSURANCE COMPANY | $360 | $0 | $360 | 5.32% |
| DDI BENEFITS INC.3 | 13435 NE WHITAKER WAY PORTLAND, OR 97230 | CONTINENTAL AMERICAN INSURANCE COMPANY | $102 | $0 | $102 | 1.51% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 1089 LAKE WASHINGTON BLVD N RENTON, WA 98056 | CONTINENTAL AMERICAN INSURANCE COMPANY | $47 | $0 | $47 | 0.69% |
| ERIC DANIEL WEILAND3 Filed as: ERIC D WEILAND | 14511 SW CORNERS TONE LANE SHERWOOD, OR 97140 | CONTINENTAL AMERICAN INSURANCE COMPANY | $14 | $0 | $14 | 0.21% |
| MICHAEL C WALKER3 Filed as: MICHAEL M STASTNY | 650 NE HOLLADAY STREET SUITE 1600 PORTLAND, OR 97232 | CONTINENTAL AMERICAN INSURANCE COMPANY | $14 | $0 | $14 | 0.21% |
| BRIAN L HUGGER3 | 10117 SE SUNNYSIDE RD SUITE F52 CLACKAMAS, OR 97015 | CONTINENTAL AMERICAN INSURANCE COMPANY | $7 | $0 | $7 | 0.10% |
| MATTHEW S SHROYER3 | 7407 N WILLIAMS AVE PORTLAND, OR 97217 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
| SUE B MARTINES4 Filed as: SUE B. MARTINES | 1665 NW HIGHLAND DR CORVALLIS, OR 97330 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $257 | $0 | $257 | 20.45% |
| CURTIS A. ALMQUIST4 | 301 S. JAMES STREET SILVERTON, OR 97381 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $196 | $0 | $196 | 15.59% |
| DALE ALLEN NICHOLS3 | 728 LEGENDS CREST DRIVE FRANKLIN, TN 37069 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $59 | $0 | $59 | 4.70% |
| 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 | $30 | $0 | $30 | 2.39% |
| DDI BENEFITS INC.3 Filed as: DDI BENEFITS | PO BOX 13090 PORTLAND, OR 97213 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.08% |
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 | 94 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | 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 | 274 | $1.0M |
| Dental | STANDARD INSURANCE COMPANY | 103 | $115K |
| Vision | PROVIDENCE HEALTH PLAN | 274 | $1.0M |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 94 | $59K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 94 | $59K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 94 | $59K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 274 | $1.0M |
| Other(5 contracts, 5 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 102 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 274 | — |
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.