| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PACIFIC BENEFIT CONSULTANTS3 Filed as: PACIFIC BENEFIT CONSULTANTS, INC. | 450 COUNTRY CLUB ROAD, SUITE 330 EUGENE, OR 974016078 | PROVIDENCE HEALTH PLAN | $15K | — | $15K | 1.60% |
| PACIFIC BENEFIT CONSULTANTS3 Filed as: PACIFIC BENEFIT CONSULTANTS INC | 450 COUNTRY CLUB RD STE 330 EUGENE, OR 974016078 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 5.00% |
| JEANNETTE R. FRANSEN3 Filed as: JEANNETTE R FRANSEN | 131 N 65TH PLACE SPRINGFIELD, OR 97478 | AFLAC | $4K | $83 | $4K | 6.60% |
| DAVID FRANSEN3 | 131 N 65TH PLACE SPRINGFIELD, OR 97478 | AFLAC | $3K | $158 | $3K | 6.13% |
| GUY R SOUTER3 | 2350 OAKMONT WAY STE 207 EUGENE, OR 97401 | AFLAC | $738 | $46 | $784 | 1.39% |
| JEROMY E. CILLEY3 | 116 HWY 99N STE 108 EUGENE, OR 97402 | AFLAC | $630 | $20 | $650 | 1.15% |
| PAUL MICHAEL HANNANT3 | 7180 SW FIR LOOP STE 250 TIGARD, OR 97223 | AFLAC | $510 | $3 | $513 | 0.91% |
| MARCI MARIE OTIS3 | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $451 | — | $451 | 0.80% |
| JEROMY E. CILLEY3 Filed as: JEROMY E CILLEY | 4660 MAIN STREET BUILDING B SUITE 300 2 SPRINGFIELD OR, OR 97478 | AFLAC | $441 | $10 | $451 | 0.80% |
| DIANA CABRAL RENTCHLER3 | PO BOX 54 WEST SACRAMENTO, CA 95691 | AFLAC | $413 | $22 | $435 | 0.77% |
| BRUCE W. FORD3 | PO BOX 5734 KENT, WA 98064 | AFLAC | $333 | — | $333 | 0.59% |
| JAMES S SARANTIS3 | 1100 CORPORATE WAY STE 100 SACRAMENTO, CA 95831 | AFLAC | $233 | $4 | $237 | 0.42% |
| KIMBERLY A PARKS3 | 3702 30TH AVE SE OLYMPIA, WA 98501 | AFLAC | $207 | $16 | $223 | 0.40% |
| PAUL J BRIDGEMAN3 Filed as: PAUL BRIDGEMAN | 1600 B SW DASH POINT RD 263 FEDERAL WAY, WA 98023 | AFLAC | $205 | — | $205 | 0.36% |
| RAYMON P KEECH III3 | 8207 CAMPAIGN CIRCLE RICHMOND, TX 77406 | AFLAC | $124 | $45 | $169 | 0.30% |
| MARK D LUTHER3 | 804 MOOREFIELD PARK DRIVE STE 205 NORTH CHESTERFIELD, VA 23236 | AFLAC | $163 | — | $163 | 0.29% |
| G SCOTT COOKE3 Filed as: SCOTT E. NIELSEN | 1089 LAKE WASHINGTON BLVD N APT 306 RENTON, WA 98056 | AFLAC | $147 | — | $147 | 0.26% |
| DAVID N GUSTAFSON3 | 340 EAST 41ST AVENUE EUGENE, OR 97405 | AFLAC | $135 | — | $135 | 0.24% |
| RICHARD G MCGOWAN3 Filed as: RICHARD MARK SUMMERS | 450 COUNTRY CLUB RD STE330 EUGENE, OR 97401 | AFLAC | $122 | — | $122 | 0.22% |
| CARLOS J. TORRES LAO3 | 6112 SW 18TH DR APT 12 PORTLAND, OR 97239 | AFLAC | $90 | — | $90 | 0.16% |
| MARY POHLMAN3 | 6102 90TH AVE SE MERCER ISLAND, WA 98040 | AFLAC | $72 | — | $72 | 0.13% |
| DAVID B. KITCHEN3 Filed as: DAVID B KITCHEN | 1260 N DUTTON AVE STE 180 SANTA ROSA, CA 95401 | AFLAC | $71 | — | $71 | 0.13% |
| BRADLEY R. SWANK3 Filed as: BRADLEY R SWANK | PO BOX 872 SPRINGFIELD, OR 97477 | AFLAC | $61 | — | $61 | 0.11% |
| BRANDON PENKO3 Filed as: BRANDON C HOOBLER | 14220 INTERURBAN AVE S STE 150 SEATTLE, WA 98168 | AFLAC | $48 | — | $48 | 0.09% |
| ROBERT PILKENTON3 Filed as: ROBERT L PILKENTON | 1100 CORPORATE WAY STE 100 SACRAMENTO, CA 95831 | AFLAC | $38 | $4 | $42 | 0.07% |
| LES HEINSEN INS SERVICES INC3 Filed as: LES HEINSEN INS SERVICES INC. | 193 BLUE RAVINE RD STE 140 FOLSOM, CA 95630 | AFLAC | $35 | $4 | $39 | 0.07% |
| DAVID J MCCLELLAN3 Filed as: DAVID JOHN HANNANT | 14830 NE 167TH ST WOODINVILLE, WA 98072 | AFLAC | $38 | — | $38 | 0.07% |
| MARY L ZACHARY3 | 18830 NW UKIAH ST PORTLAND, OR 97229 | AFLAC | $32 | — | $32 | 0.06% |
| LISA M HUTCHERSON3 | 193 BLUE RAVINE ROAD STE 140 FOLSOM, CA 95630 | AFLAC | $31 | — | $31 | 0.05% |
| PHIL E DIETMEYER3 | 8275 SW COLONY CREEK CT TIGARD, OR 97224 | AFLAC | $25 | — | $25 | 0.04% |
| PAUL A MARSHALL3 | 555 S RENTON VILLAGE PLACE SUITE 160 RENTON, WA 98057 | AFLAC | $22 | — | $22 | 0.04% |
| ANGELA MARIE MCCOY3 | 5411 SW JOSHUA ST TUALATIN, OR 97062 | AFLAC | $18 | — | $18 | 0.03% |
| TODD M TAYLOR3 Filed as: TODD TAYLOR | 1720 TABOR ST EUGENE, OR 97401 | AFLAC | $18 | — | $18 | 0.03% |
| HARRY R CONRAD3 | 2140 ELYSIUM AVE EUGENE, OR 97401 | AFLAC | $17 | — | $17 | 0.03% |
| GLEN T SCHWEIKERT3 Filed as: GLEN W SUGGS | 2254 72ND AVE SE MERCER ISLAND, WA 98040 | AFLAC | $17 | — | $17 | 0.03% |
| ROBERTA LOU DIETMEYER3 | 8275 SW COLONY CREEK CT TIGARD, OR 97224 | AFLAC | $15 | — | $15 | 0.03% |
| ERNEST E SNOOK3 Filed as: ERNEST E. SNOOK | 14011 282ND LN NE DUVALL, WA 98019 | AFLAC | $15 | — | $15 | 0.03% |
| CAMERON CARRILLO3 Filed as: CAMERON D CARRILLO | 22556 SW 96TH DR TUALATIN, OR 97062 | AFLAC | $14 | — | $14 | 0.02% |
| CHRISTOPHER WALLACE HOFF3 | 121 ROCKY POINT CT ACWORTH, GA 30101 | AFLAC | $13 | — | $13 | 0.02% |
| BARRY MCPHERSON INC3 | 2211 MICHELSON DR SUITE 1150 IRVINE, CA 92612 | AFLAC | $11 | — | $11 | 0.02% |
| STANLEY A MCPHERSON3 | 2137 NE 38TH DR GRESHAM, OR 97030 | AFLAC | $9 | — | $9 | 0.02% |
| PETER JAMES SARANTIS3 | 2251 DOUGLAS BLVD STE 110 ROSEVILLE, CA 95661 | AFLAC | $8 | — | $8 | 0.01% |
| RUSSELL HONDA3 Filed as: RUSSELL K HONDA | 21932 SW CREEK DR TUALATIN, OR 97062 | AFLAC | $8 | — | $8 | 0.01% |
| SCOTT W BLACKSHEAR3 | 3453 CATHRYN DR COLUMBUS, GA 31906 | AFLAC | $5 | — | $5 | 0.01% |
| MICHAEL C WALKER3 Filed as: MICHAEL L ALLEY | 5200 MEADOWS ROAD STE 150 LAKE OSWEGO, OR 97035 | AFLAC | $4 | — | $4 | 0.01% |
| BARRY A WHITE3 | 4506 BANTAM WAY ELK GROVE, CA 95758 | AFLAC | $3 | — | $3 | 0.01% |
| BONNIE LOUESE MCCREERY3 | 1307 HEMLOCK ST LAKE OSWEGO, OR 97034 | AFLAC | $2 | — | $2 | 0.00% |
| CONSUELO M VENTURA3 | 13960 SW SCHOLLS FRY ROAD UNIT 105 BEAVERTON, OR 97007 | AFLAC | $2 | — | $2 | 0.00% |
| JERRY OLIVER CREECH3 | 233 MIDDLE ST STE 107A NEW BERN, NC 28560 | AFLAC | $1 | — | $1 | 0.00% |
| PAUL B ROBEDEAU3 | 9523 BAY CT CARMEL, CA 93923 | AFLAC | $1 | — | $1 | 0.00% |
| PACIFIC BENEFIT CONSULTANTS3 | 450 COUNTRY CLUB RD STE 330 EUGENE, OR 974016078 | VISION SERVICE PLAN | $1K | — | $1K | 5.20% |
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 | 264 | 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) | 265 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 264 | $965K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 233 | $119K |
| Vision | VISION SERVICE PLAN | 183 | $23K |
| Short-term disability | AFLAC | 123 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 264 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.