| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHELLI LITTLEFIELD3 | PACIFIC BENEFIT CONSULTANTS, INC. 450 COUNTRY CLUB ROAD, SUITE 330 EUGENE, OR 974016078 | PROVIDENCE HEALTH PLAN | $36K | — | $36K | 2.80% |
| 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 | 131 65TH PL. SPRINGFIELD, OR 97478 | AFLAC | $4K | $25 | $5K | 7.28% |
| DAVID FRANSEN3 | 131 65TH PL. SPRINGFIELD, OR 97478 | AFLAC | $2K | $13 | $2K | 3.86% |
| JEROMY E. CILLEY3 | 4660 MAIN ST. BLDG B STE 300 2 SPRINGFIELD, OR 97478 | AFLAC | $1K | $8 | $1K | 2.15% |
| GUY R SOUTER3 Filed as: GUY R. SOUTER | 16280 PINE DROP LN LA PINE, OR 97739 | AFLAC | $670 | $8 | $678 | 1.10% |
| PHIL E DIETMEYER3 | 8275 SW COLONY CREEK CT TIGARD, OR 97224 | AFLAC | $428 | $11 | $439 | 0.71% |
| DIANA CABRAL RENTCHLER3 | PO BOX 54 WEST SACRAMENTO, CA 95691 | AFLAC | $418 | — | $418 | 0.68% |
| MARCI MARIE OTIS3 | 200 JULINA LN ROSEBURG, OR 97471 | AFLAC | $362 | — | $362 | 0.59% |
| PHILIP O MCGUIGAN3 Filed as: PHILIP O. MCGUIGAN | 4660 MAIN ST. BLDG B SUITE 300-2 SPRINGFIELD, OR 97478 | AFLAC | $282 | — | $282 | 0.46% |
| JAMES S SARANTIS3 Filed as: JAMES S. SARANTIS | 2251 DOUGLAS BLVD STE 110 ROSEVILLE, CA 95661 | AFLAC | $211 | — | $211 | 0.34% |
| PAUL J BRIDGEMAN3 Filed as: PAUL J. BRIDGEMAN | 1600 B SW DASH POINT ROAD 263 FEDERAL WAY, WA 98023 | AFLAC | $205 | — | $205 | 0.33% |
| KIMBERLY A PARKS3 Filed as: KIMBERLY A. PARKS | 3702 30TH AVE SE OLYMPIA, WA 98501 | AFLAC | $132 | — | $132 | 0.21% |
| DAVID N GUSTAFSON3 Filed as: DAVID N. GUSTAFSON | 340 EAST 41ST AVE EUGENE, OR 97405 | AFLAC | $125 | — | $125 | 0.20% |
| BRUCE W. FORD3 | PO BOX 5734 KENT, WA 98064 | AFLAC | $121 | — | $121 | 0.20% |
| CARLOS J. TORRES LAO3 | 7180 SW FIR LOOP STE 250 TIGARD, OR 97223 | AFLAC | $120 | — | $120 | 0.19% |
| SCOTT NIELSEN3 Filed as: SCOTT E. NEILSEN | 1089 LAKE WASHINGTON BLVD N APT 306 RENTON, WA 98056 | AFLAC | $117 | — | $117 | 0.19% |
| MARK D LUTHER3 Filed as: MARK D. LUTHER | 804 MOOREFIELD PARK DR. STE 205 NORTH CHESTERFIELD, VA 23236 | AFLAC | $112 | — | $112 | 0.18% |
| PAUL MICHAEL HANNANT3 | 7180 SW FIR LOOP STE 250 TIGARD, OR 97223 | AFLAC | $75 | $3 | $78 | 0.13% |
| RICHARD G MCGOWAN3 Filed as: RICHARD MARK SUMMERS | 450 COUNTRY CLUB RD STE 330 EUGENE, OR 97401 | AFLAC | $74 | — | $74 | 0.12% |
| BRADLEY R. SWANK3 | PO BOX 872 SPRINGFIELD, OR 97477 | AFLAC | $71 | — | $71 | 0.11% |
| IOANNIS T GRATSINOPOULOS3 Filed as: IOANNIS T. GRATSINOPOULOS | 3565 SUMMERLINN DR WEST LINN, OR 97068 | AFLAC | $60 | — | $60 | 0.10% |
| RAYMON P KEECH III3 Filed as: RAYMON P. KEECH III | 8207 CAMPAIGN CIR. RICHMOND, TX 77406 | AFLAC | $45 | — | $45 | 0.07% |
| LEON NORMAN DAVIDSON3 | 1100 CORPORATE WAY STE 100 SACRAMENTO, CA 95831 | AFLAC | $37 | — | $37 | 0.06% |
| ROBERT PILKENTON3 Filed as: ROBERT L. PILKENTON | 1100 CORPORATE WAY STE 100 SACRAMENTO, CA 95831 | AFLAC | $36 | — | $36 | 0.06% |
| MARY POHLMAN3 | 14220 INTERURBAN AVE. S. STE 150 TUKWILA, WA 98168 | AFLAC | $32 | — | $32 | 0.05% |
| LISA M HUTCHERSON3 Filed as: LISA M. HUTCHERSON | 193 BLUE RAVINE RD. STE 140 FOLSOM, CA 95630 | AFLAC | $31 | — | $31 | 0.05% |
| RUSSELL HONDA3 Filed as: RUSSELL K. HONDA | 21932 SW CREEK DR. TUALATIN, OR 97062 | AFLAC | $30 | — | $30 | 0.05% |
| BRANDON PENKO3 Filed as: BRANDON C. HOOBLER | 14220 INTERURBAN AVE S STE 150 SEATTLE, WA 98168 | AFLAC | $25 | — | $25 | 0.04% |
| LEON NORMAN DAVIDSON3 | 1230 ARROYO GRANDE DR. SACRAMENTO, CA 95864 | AFLAC | $25 | — | $25 | 0.04% |
| DAVID B. KITCHEN3 | 1260 N. DUTTON AVE STE 180 SANTA ROSA, CA 95401 | AFLAC | $24 | — | $24 | 0.04% |
| ROBERTA LOU DIETMEYER3 | 8275 SW COLONY CREEK CT. TIGARD, OR 97224 | AFLAC | $21 | $2 | $23 | 0.04% |
| PAUL A MARSHALL3 Filed as: PAUL A. MARSHALL | 555 S. RENTON VILLAGE PL. STE 160 RENTON, WA 98057 | AFLAC | $22 | — | $22 | 0.04% |
| STANLEY A MCPHERSON3 Filed as: STANLEY A. MCPHERSON | 2137 NE 38TH DR. GRESHAM, OR 97030 | AFLAC | $17 | $3 | $20 | 0.03% |
| HARRY R CONRAD3 Filed as: HARRY R. CONRAD | 2140 ELYSIUM AVE EUGENE, OR 97401 | AFLAC | $17 | — | $17 | 0.03% |
| GLEN T SCHWEIKERT3 Filed as: GLEN W. SUGGS | 2254 72ND AVENUE SE MERCER ISLAND, WA 98040 | AFLAC | $17 | — | $17 | 0.03% |
| JACOB J MCINTOSH3 Filed as: JACOB J. MCINTOSH | 7180 SW FIR LOOP STE 250 TIGARD, OR 97223 | AFLAC | $16 | — | $16 | 0.03% |
| TODD M TAYLOR3 Filed as: TODD M. TAYLOR | 1720 TABOR ST. EUGENE, OR 97401 | AFLAC | $15 | — | $15 | 0.02% |
| MARY POHLMAN3 | 6102 90TH AVE. SE MERCER ISLAND, WA 98040 | AFLAC | $15 | — | $15 | 0.02% |
| ERNEST E SNOOK3 Filed as: ERNEST E. SNOOK | 14011 282ND LN. NE DUVALL, WA 98019 | AFLAC | $14 | — | $14 | 0.02% |
| SHANE EDMUND ATTEBERY3 | 1250 N DUTTON AVE. STE 180 SANTA ROSA, CA 95401 | AFLAC | $12 | — | $12 | 0.02% |
| BARRY MCPHERSON INC3 Filed as: BARRY MCPHERSON INC. | 2211 MICHELSON DR. STE 1150 IRVINE, CA 92612 | AFLAC | $11 | — | $11 | 0.02% |
| ANGELA MARIE MCCOY3 | 5411 SW JOSHUA ST. TUALATIN, OR 97062 | AFLAC | $10 | — | $10 | 0.02% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $9 | — | $9 | 0.01% |
| LES HEINSEN INS SERVICES INC3 Filed as: LES HEINSEN INS SERVICES INC. | 4416 VIA PALAGIO FAIR OAKS, CA 95628 | AFLAC | $8 | — | $8 | 0.01% |
| MARY L ZACHARY3 Filed as: MARY L. ZACHARY | 18830 NW UKIAH ST. PORTLAND, OR 97229 | AFLAC | $7 | — | $7 | 0.01% |
| PETER JAMES SARANTIS3 | 2251 DOUGLAS BLVD STE 110 ROSEVILLE, CA 95661 | AFLAC | $7 | — | $7 | 0.01% |
| SHELBIE NICOLE DIETMEYER3 | 8275 SW COLONY CREEK CT. TIGARD, OR 97224 | AFLAC | $5 | $2 | $7 | 0.01% |
| CAMERON CARRILLO3 Filed as: CAMERON D. CARRILLO | 22556 SW 96TH DR. TUALATIN, OR 97062 | AFLAC | $5 | — | $5 | 0.01% |
| SCOTT W BLACKSHEAR3 Filed as: SCOTT W. BLACKSHEAR | 3453 CATHRYN DR. COLUMBUS, GA 31906 | AFLAC | $5 | — | $5 | 0.01% |
| MICHAEL C WALKER3 Filed as: MICHAEL L. ALLEY | 5200 MEADOWS RD. STE 150 LAKE OSWEGO, OR 97035 | AFLAC | $4 | — | $4 | 0.01% |
| BARRY LEE JOHNSON3 | 4890 48TH LOOP SWEET HOME, OR 97386 | AFLAC | $4 | — | $4 | 0.01% |
| MATTHEW G BERGER3 Filed as: MATTHEW SHROYER | 7407 N WILLIAMS AVE. PORTLAND, OR 97217 | AFLAC | $4 | — | $4 | 0.01% |
| DAVID J MCCLELLAN3 Filed as: DAVID JOHN HANNANT | 14830 NE 167TH ST. WOODINVILLE, WA 98072 | AFLAC | $3 | — | $3 | 0.00% |
| JAMES F TUOR3 Filed as: JAMES F. TUOR | 22416 N. ARRELLAGA DR. SUN CITY WEST, AZ 85375 | AFLAC | $3 | — | $3 | 0.00% |
| MICHAEL C WALKER3 Filed as: MICHAEL A. STACHOWIAK | 12121 WILSHIRE BLVD LOS ANGELES, CA 90025 | AFLAC | $3 | — | $3 | 0.00% |
| GINA SIENIA3 | 8710 SW ASH MEADOWS RD. APT. 1137 WILSONVILLE, OR 97070 | AFLAC | $3 | — | $3 | 0.00% |
| MICHAEL C WALKER3 Filed as: MICHAEL M. STASTNY | 650 NE HOLLADAY ST. STE 1600 PORTLAND, OR 97232 | AFLAC | $3 | — | $3 | 0.00% |
| CHRISTOPHER WALLACE HOFF3 | 121 ROCKY POINT CT. ACWORTH, GA 30101 | AFLAC | $2 | — | $2 | 0.00% |
| BARRY A WHITE3 Filed as: BARRY A. WHITE | 4506 BANTAM WAY ELK GROVE, CA 95758 | AFLAC | $2 | — | $2 | 0.00% |
| JEFFORY P MERTEN3 Filed as: JEFFORY P. MERTEN | 906 NW LEWISBURG AVE. CORVALLIS, OR 97330 | AFLAC | $2 | — | $2 | 0.00% |
| WILLIAM BONNER3 Filed as: WILLIAM RAYMOND BONNER | PO BOX 157 LEBANON, OR 97355 | AFLAC | $2 | — | $2 | 0.00% |
| AMANDA M GRIFFITH3 Filed as: AMANDA M. GRIFFITH | 11400 SE 8TH STREET #375 BELLEVUE, WA 98004 | AFLAC | $2 | — | $2 | 0.00% |
| MICHAEL C WALKER3 Filed as: MICHAEL JAMES RHODD | 2818 ROCKVILLE RD. FAIRFIELD, CA 94534 | AFLAC | $1 | — | $1 | 0.00% |
| PAUL B ROBEDEAU3 Filed as: PAUL B. ROBEDEAU | 9523 BAY CT. CARMEL, CA 93923 | AFLAC | $1 | — | $1 | 0.00% |
| MARK A MCRAE3 Filed as: MARK A. MCRAE | PO BOX 727 CORVALLIS, OR 97339 | AFLAC | $1 | — | $1 | 0.00% |
| PETER JAMES SARANTIS3 | 2251 DOUGLAS BLVD SUITE 110 ROSEVILLE, CA 95661 | AFLAC | $1 | — | $1 | 0.00% |
| RUSSELL W REOPELLE3 Filed as: RUSSELL W. REOPELLE | 1211 BILLY FRANK JR. ST. APT. 1 BELLINGHAM, WA 98225 | AFLAC | $1 | — | $1 | 0.00% |
| AMY E COHEN3 Filed as: AMY MARIE LUDWICK | 7403 SESAME ST. COLUMBUS, GA 31908 | AFLAC | $1 | — | $1 | 0.00% |
| CRAIG A HANSEN3 Filed as: CRAIG A. HANSEN | 200 17TH AVE. E. APT. 404 SEATTLE, WA 98112 | AFLAC | $1 | — | $1 | 0.00% |
| BRIAN E DICKSON3 Filed as: BRIAN E. DICKSON | 8905 SW NIMBUS AVE. 375 BEAVERTON, OR 97008 | AFLAC | $1 | — | $1 | 0.00% |
| MJ INSURANCE3 Filed as: ROBIN D. HUDSON | PO BOX 1124 ASTORIA, OR 97103 | AFLAC | $1 | — | $1 | 0.00% |
| SIERRA N KIRSHY3 Filed as: SIERRA N. KIRSHY | 348 DIAMOND OAKS RD. ROSEVILLE, CA 95678 | AFLAC | $1 | — | $1 | 0.00% |
| JOSHUA PAUL GROUP INC3 Filed as: JOSHUA M. HELDEROP | 234 5TH AVE. KIRKLAND, WA 98033 | AFLAC | $1 | — | $1 | 0.00% |
| PACIFIC BENEFIT CONSULTANTS3 | 450 COUNTRY CLUB RD STE 330 EUGENE, OR 974016078 | VISION SERVICE PLAN | $1K | — | $1K | 5.01% |
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 | 284 | 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) | 285 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 284 | $1.3M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 218 | $115K |
| Vision | VISION SERVICE PLAN | 190 | $25K |
| Short-term disability | AFLAC | 120 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 284 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.