| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANDREW N LUCCOCK3 | PO BOX 1965 WILSONVILLE, OR 97070 | AFLAC | $1K | $90 | $1K | 13.53% |
| DDI BENEFITS INC.3 Filed as: DDI BENEFITS | 13435 NE WHITAKER WAY PORTLAND, OR 97230 | AFLAC | $371 | $0 | $371 | 4.17% |
| JACOB J MCINTOSH3 | 7180 SW FIR LOOP, SUITE 250 TIGARD, OR 97223 | AFLAC | $121 | $18 | $139 | 1.56% |
| GINA L GAXIOLA3 | 730 MANDEVILLA WAY CORONA, CA 92879 | AFLAC | $99 | $0 | $99 | 1.11% |
| BRIDGET RENEA TOWNSEND3 | 5005 MEADOWS RD., SUITE 140 LAKE OSWEGO, OR 97035 | AFLAC | $58 | $0 | $58 | 0.65% |
| JULIE L WOLD3 | 495 E RINCON ST., SUITE 212 CORONA, CA 92879 | AFLAC | $23 | $0 | $23 | 0.26% |
| NOLA EVANS INC3 Filed as: NOLA EVANS INC. | 1111 N PONDEROSA STREET CANBY, OR 97013 | AFLAC | $23 | $0 | $23 | 0.26% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 1089 LAKE WASHINGTON BLVD. N APT 306 RENTON, WA 98056 | AFLAC | $20 | $0 | $20 | 0.22% |
| LARRY SHERWOOD & ASSOCIATES INC3 Filed as: LARRY SHERWOOD & ASSOCIATES INC. | 10220 SW GREENBURG ROAD #225 PORTLAND, OR 97223 | AFLAC | $18 | $0 | $18 | 0.20% |
| JERRY OLIVER CREECH3 | 233 MIDDLE STREET, SUITE 107A NEW BERN, NC 28560 | AFLAC | $18 | $0 | $18 | 0.20% |
| DAWN T SUCHECKI3 | 3850 VINE STREET SUITE 130 RIVERSIDE, CA 92507 | AFLAC | $15 | $0 | $15 | 0.17% |
| ANDREW PRINCE LOVINGIER3 | 1817 BLOYD STREET KELSO, WA 98626 | AFLAC | $12 | $0 | $12 | 0.13% |
| BRYAN JORAMO3 | 2606 STRASBURG DR FOREST GROVE, OR 97116 | AFLAC | $11 | $0 | $11 | 0.12% |
| ZINA SHADRIN3 | PO BOX 1704 LAKE OSWEGO, OR 97035 | AFLAC | $7 | $0 | $7 | 0.08% |
| IOANNIS T GRATSINOPOULOS3 | 3565 SUMMERLINN DR WEST LINN, OR 97068 | AFLAC | $6 | $0 | $6 | 0.07% |
| MICHAEL C WALKER3 Filed as: MICHAEL M STASTNY | 605 PORTLAND AVE UNIT 531 GLADSTONE, OR 97027 | AFLAC | $6 | $0 | $6 | 0.07% |
| RITA J ROBINSON3 | 21780 WILLAMETTE DR SUITE B WEST WEST LINN, OR 97068 | AFLAC | $6 | $0 | $6 | 0.07% |
| BRIAN L HUGGER3 | 10117 SE SUNNYSIDE RD SUITE F52 CLACKAMAS, OR 97015 | AFLAC | $4 | $0 | $4 | 0.04% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $3 | $0 | $3 | 0.03% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH H WILLIS JR | 1431 NE 55TH STREET FORT LAUDERDALE, FL 33334 | AFLAC | $2 | $0 | $2 | 0.02% |
| CAMERON CARRILLO3 | 22556 SW 96TH DR TUALATIN, OR 97062 | AFLAC | $1 | $0 | $1 | 0.01% |
| MATTHEW G BERGER3 Filed as: MATTHEW SHROYER | 7407 N WILLIAMS AVE PORTLAND, OR 97217 | AFLAC | $1 | $0 | $1 | 0.01% |
| TERRI PEASE3 | 1113 MEDINA ROAD SUITE 500 MEDINA, OH 44256 | AFLAC | $276 | $25 | $301 | 6.36% |
| TERRI PEASE3 | PO BOX 753 WADSWORTH, OH 44282 | AFLAC | $134 | $11 | $145 | 3.06% |
| THOMAS A HOUSE3 Filed as: THOMAS A HOUSE JR | 100 ASHLEIGH DR BRUNSWICK, OH 44212 | AFLAC | $73 | $0 | $73 | 1.54% |
| ASHLEY GRASER3 | 1113 MEDINA RD., SUITE 500 MEDINA, OH 44256 | AFLAC | $60 | $7 | $67 | 1.41% |
| A C LONG & ASSOCIATES INC3 Filed as: AC LONG & ASSOCIATES INC. | 1113 MEDINA RD., SUITE 500 MEDINA, OH 44256 | AFLAC | $47 | $5 | $52 | 1.10% |
| JOSEPH MANGANO3 | 6100 OAK TREE BLVD., SUITE 200 INDEPENDENCE, OH 44131 | AFLAC | $46 | $0 | $46 | 0.97% |
| THOMAS A HOUSE3 | 1089 HARMONY LANE CLERMONT, FL 34711 | AFLAC | $33 | $0 | $33 | 0.70% |
| A C LONG & ASSOCIATES INC3 Filed as: AC LONG & ASSOCIATES INC. | 1113 MEDINA ROAD, SUITE 500 MEDINA, OH 44256 | AFLAC | $10 | $2 | $12 | 0.25% |
| HARE AND ASSOCIATES LLC3 | 470 OLDE WORTHINGTON RD., SUITE 250 WESTERVILLE, OH 43082 | AFLAC | $8 | $0 | $8 | 0.17% |
| MAKOWSKI INS AGCY INC3 Filed as: MAKOWSKI INS AGENCY INC. | 9404 WOODCHIP LN BROADVIEW HEIGHTS, OH 44147 | AFLAC | $6 | $0 | $6 | 0.13% |
| ROBERTA DICKINSON3 Filed as: ROBERTA S DICKINSON | PO BOX 360277 STRONGSVILLE, OH 44136 | AFLAC | $5 | $0 | $5 | 0.11% |
| OPPORTUNITY INC3 Filed as: OPPORTUNITY INC. | 9404 WOODCHIP LN BROADVIEW HEIGHTS, OH 44147 | AFLAC | $4 | $0 | $4 | 0.08% |
| JACK A SHADE3 | 690 TREE BEND CT WESTERVILLE, OH 43082 | AFLAC | $3 | $0 | $3 | 0.06% |
| JOHN D SUSIE3 | 8682 HAWICK CT. N DUBLIN, OH 43017 | AFLAC | $1 | $0 | $1 | 0.02% |
| CURTIS A. ALMQUIST4 | 301 S. JAMES STREET SILVERTON, OR 97381 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $94 | $0 | $94 | 7.93% |
| SUE B MARTINES4 Filed as: SUE B. MARTINES | 1665 NW HIGHLAND DR CORVALLIS, OR 97330 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $56 | $0 | $56 | 4.73% |
| DALE ALLEN NICHOLS3 | 728 LEGENDS CREST DRIVE FRANKLIN, TN 37069 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $77 | $0 | $77 | 8.24% |
| 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 | $33 | $0 | $33 | 3.53% |
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 | 114 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 235 | $1.3M |
| Dental | STANDARD INSURANCE COMPANY | 116 | $133K |
| Vision | PROVIDENCE HEALTH PLAN | 235 | $1.3M |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 114 | $70K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 114 | $70K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 114 | $70K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 235 | $1.3M |
| Other(6 contracts, 5 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 116 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 235 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.