| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC3 Filed as: NIEDERMEYER RISK MANAGEMENT | 9340 SW BEAVERTON SUITE A HILLSDALE HIGHWAY BEAVERTON, OR 97005 | HEATH NET | $33K | — | $33K | 2.49% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: NIEDERMEYER RISK MANAGEMENT LLC | 9340 SW BEAVERTON STE A HILLSDALE HWY BEAVERTON, OR 970053301 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 1.70% |
| PAULLA ANN WALKER3 | 601 IDYLWOOD DR SE SALEM, OR 97302 | AFLAC | $6K | $527 | $7K | 18.40% |
| VINCENT BRIAN VOLLMAR3 | 3295 TRIANGLE DR SE STE 120 SALEM, OR 97302 | AFLAC | $984 | $96 | $1K | 3.06% |
| PETER JOHN MARTIN3 | 350 13TH ST NE APT 208 SALEM, OR 97301 | AFLAC | $804 | $81 | $885 | 2.50% |
| ROBERT BRIGHAM SAFFEELS3 | 5557 7TH AVE SE SALEM, OR 97306 | AFLAC | $783 | $54 | $837 | 2.37% |
| SHAWN NEVIN3 | 5845 HACIENDA AVE LINCOLN CITY, OR 97367 | AFLAC | $592 | $4 | $596 | 1.69% |
| ERINN BERBERICK3 | 239 SILVER LOOP SILVERTON, OR 97381 | AFLAC | $156 | — | $156 | 0.44% |
| DAVID J MCCLELLAN3 Filed as: DAVID JOHN HANNANT | 14830 NE 167TH ST WOODINVILLE, WA 98072 | AFLAC | $55 | — | $55 | 0.16% |
| WILLIAM R MEDITZ3 | 25884 SW CANYON CREEK RD APT J202 WILSONVILLE, OR 97070 | AFLAC | $53 | — | $53 | 0.15% |
| CAROLYN LENARD3 | 3742 LOLO PASS WAY NE APT 106 SALEM, OR 97305 | AFLAC | $50 | — | $50 | 0.14% |
| ALICIA J MATSON3 | 6027 ROLLETTI DR SE SALEM, OR 97306 | AFLAC | $49 | — | $49 | 0.14% |
| LARRI B WHEELER3 | 81640 LOST VALLEY LN DEXTER, OR 97431 | AFLAC | $42 | — | $42 | 0.12% |
| JAMES F TUOR3 | 22416 N ARRELLAGA DR SUN CITY WEST, AZ 85375 | AFLAC | $41 | — | $41 | 0.12% |
| NATHAN HANSEN3 | 745 E DUSTY CREEK AVE SANDY, UT 84094 | AFLAC | $25 | — | $25 | 0.07% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 718B W FOURTH PLAIN BLVD VANCOUVER, WA 98660 | AFLAC | $21 | — | $21 | 0.06% |
| GUY R SOUTER3 | PO BOX 1283 LA PINE, OR 97739 | AFLAC | $18 | — | $18 | 0.05% |
| DAVID FRANSEN3 | 131 65TH PL SPRINGFIELD, OR 97478 | AFLAC | $16 | — | $16 | 0.05% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 2709 DAY ISLAND BLVD W UNIT A UNIVERSITY PL, WA 98466 | AFLAC | $16 | — | $16 | 0.05% |
| GUY R SOUTER3 | 16280 PINE DROP LN LA PINE, OR 97739 | AFLAC | $15 | — | $15 | 0.04% |
| ANDRIA R. KINYON3 Filed as: ANDRIA R KINYON | 11045 WAYPARK DR NE SALEM, OR 97305 | AFLAC | $13 | — | $13 | 0.04% |
| JOSEPH P TYRRELL3 | 468 E FOREST RIDGE DR MERIDIAN, ID 83642 | AFLAC | $11 | — | $11 | 0.03% |
| CHERYL DOWNING3 | 496 INVERNESS DR SE SALEM, OR 97306 | AFLAC | $9 | — | $9 | 0.03% |
| MICHAEL C WALKER3 Filed as: MICHAEL L ALLEY | 18047 SW LOWER BOONES FERRY RD APT 415 TIGARD, OR 97224 | AFLAC | $8 | — | $8 | 0.02% |
| RAYMON P KEECH III3 | 8207 CAMPAIGN CIR RICHMOND, TX 77406 | AFLAC | $5 | — | $5 | 0.01% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $3 | — | $3 | 0.01% |
| GINA SIENIA3 | PO BOX 446 ECHO, OR 97826 | AFLAC | $2 | — | $2 | 0.01% |
| IOANNIS T GRATSINOPOULOS3 | 3565 SUMMERLINN DR WEST LINN, OR 97068 | AFLAC | $2 | — | $2 | 0.01% |
| SHANE EDMUND ATTEBERY3 | 391 RANDY DR GRANTS PASS, OR 97527 | AFLAC | $2 | — | $2 | 0.01% |
| ROBIN D HUDSON3 | 15000 DAVIS LN APT 80 LAKE OSWEGO, OR 97035 | AFLAC | $1 | — | $1 | 0.00% |
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 | 217 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 217 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEATH NET | 220 | $1.3M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 370 | $117K |
| Vision | HEATH NET | 220 | $1.3M |
| Other | AFLAC | 41 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 370 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
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.