| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANDREW N LUCCOCK3 | 19766 WILDWOOD DR WEST LINN, OR 97068 | AFLAC | $342 | $0 | $342 | 3.48% |
| TERRI PEASE3 | 567 SAGUARO PL BARBERTON, OH 44203 | AFLAC | $241 | $0 | $241 | 2.45% |
| DDI BENEFITS INC.3 Filed as: DDI BENEFITS | 2111 NE HALSEY ST PORTLAND, OR 97232 | AFLAC | $143 | $0 | $143 | 1.45% |
| BRIDGET RENEA TOWNSEND3 | 28317 SW PARIS AVE WILSONVILLE, OR 97070 | AFLAC | $64 | $0 | $64 | 0.65% |
| SARAH L PAVLOVICH3 Filed as: SARAH PAVLOVICH | 2575 MEDINA RD SUITE 1 MEDINA, OH 44256 | AFLAC | $39 | $0 | $39 | 0.40% |
| THOMAS A HOUSE3 Filed as: THOMAS A HOUSE JR | 100 AHLEIGH DR BRUNSWICK, OH 44212 | AFLAC | $39 | $0 | $39 | 0.40% |
| ASHLEY GRASER3 Filed as: ASHLEY LOREN GRASER | 2384 INAS DR AKRON, OH 44321 | AFLAC | $23 | $0 | $23 | 0.23% |
| THOMAS A HOUSE3 | 1114 LATTIMORE DR CLERMONT, FL 34711 | AFLAC | $18 | $0 | $18 | 0.18% |
| JOSEPH MANGANO3 | 6100 OAK TREE BLVD SUITE 200 INDEPENDENCE, OH 44131 | AFLAC | $18 | $0 | $18 | 0.18% |
| JERRY OLIVER CREECH3 | 5915 SANTO DOMINGO CT NEW BERN, NC 28560 | AFLAC | $17 | $0 | $17 | 0.17% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 718B W FOURTH PLAIN BLVD VANCOUVER, WA 98660 | AFLAC | $11 | $0 | $11 | 0.11% |
| BRYAN JORAMO3 | 2606 STRASBURG DR FOREST GROVE, OR 97116 | AFLAC | $10 | $0 | $10 | 0.10% |
| JACOB J MCINTOSH3 | 665 S WOODRUFF AVE SUITE 250 IDAHO FALLS, OR 83401 | AFLAC | $10 | $0 | $10 | 0.10% |
| AMANDA C LONG3 | 107 HIDDEN OAK DR MARS, PA 16046 | AFLAC | $10 | $0 | $10 | 0.10% |
| ZINA SHADRIN3 | PO BOX 1704 LAKE OSWEGO, OR 97035 | AFLAC | $6 | $0 | $6 | 0.06% |
| RITA J ROBINSON3 | 30256 SW THOMAS ST UNIT 1106 WILSONVILLE, OR 97070 | AFLAC | $5 | $0 | $5 | 0.05% |
| BRIAN L HUGGER3 | 10117 SE SUNNYSIDE RD SUITE F52 CLACKAMAS, OR 97015 | AFLAC | $4 | $0 | $4 | 0.04% |
| HARE AND ASSOCIATES LLC3 | 6324 TARTON FIELDS LN MASON, OH 45040 | AFLAC | $3 | $0 | $3 | 0.03% |
| MAKOWSKI INS AGCY INC3 Filed as: MAKOWSKI INS AGENCY INC. | 9404 WOODCHIP LN BROADVIEW HTS, OH 44147 | AFLAC | $3 | $0 | $3 | 0.03% |
| MICHAEL C WALKER3 Filed as: MICHAEL M STASTNY | 605 PORTLAND AVE UNIT 531 GLADSTONE, OR 97027 | AFLAC | $2 | $0 | $2 | 0.02% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $2 | $0 | $2 | 0.02% |
| ROBERTA DICKINSON3 Filed as: ROBERTA S DICKINSON | 16141 HOWE RD STRONGSVILLE, OH 44136 | AFLAC | $2 | $0 | $2 | 0.02% |
| OPPORTUNITY INC3 Filed as: OPPORTUNITY INC. | 9404 WOODCHIP LN BROADVIEW HEIGHTS, OH 44147 | AFLAC | $2 | $0 | $2 | 0.02% |
| MATTHEW G BERGER3 Filed as: MATTHEW SHROYER | 1384 NE 70TH AVE PORTLAND, OR 97213 | AFLAC | $1 | $0 | $1 | 0.01% |
| CAMERON CARRILLO3 | 61503 ORION DR BEND, OH 97702 | AFLAC | $1 | $0 | $1 | 0.01% |
| JACK A SHADE3 | 690 TREE BEND CT WESTERVILLE, OH 43082 | AFLAC | $1 | $0 | $1 | 0.01% |
| CURTIS A. ALMQUIST4 | 1665 NW HIGHLAND DR CORVALLIS, OR 97330 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $111 | $0 | $111 | 6.91% |
| DALE ALLEN NICHOLS3 | 728 LEGENDS CREST DRIVE FRANKLIN, TN 37069 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $65 | $0 | $65 | 6.95% |
| 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 | $28 | $0 | $28 | 2.99% |
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 | 116 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | 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 | 233 | $1.2M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 433 | $87K |
| Vision | PROVIDENCE HEALTH PLAN | 233 | $1.2M |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 116 | $79K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 116 | $79K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 116 | $79K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 233 | $1.2M |
| Other(5 contracts, 5 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 116 | $95K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 433 | — |
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.