| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC3 Filed as: NIEDERMEYER RISK MANAGEMENT | 9340 SW BEAVERTON HILLSDALE HWY. SUITE A BEAVERTON, OR 97005 | MODA HEALTH | $29K | — | $29K | 2.46% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: NIEDERMEYER RISK MANAGEMENT | 9340 SW BEAVERTON HILLSDALE HWY. SUITE A BEAVERTON, OR 97005 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $3K | — | $3K | 2.46% |
| PAULLA ANN WALKER3 | 601 IDYLWOOD DR SE SALEM, OR 97302 | AFLAC | $2K | $168 | $3K | 9.04% |
| TAMARA MARIE QUARRY3 | 5250 HARDING LN SE TURNER, OR 97392 | AFLAC | $1K | — | $1K | 5.09% |
| VINCENT BRIAN VOLLMAR3 | 777 COMMERCIAL ST SE STE 20 SALEM, OR 97301 | AFLAC | $565 | $36 | $601 | 2.14% |
| TREVOR WILKS3 | 722 HIGHLAND AVE NE SALEM, OR 97301 | AFLAC | $356 | — | $356 | 1.27% |
| MJ INSURANCE3 Filed as: MJI INC DBA HAGAN | PO BOX 847 MCMINNVILLE, OR 97128 | AFLAC | $303 | — | $303 | 1.08% |
| PETER JOHN MARTIN3 | 350 13TH ST NE APT 208 SALEM, OR 97301 | AFLAC | $172 | — | $172 | 0.61% |
| SHAWN NEVIN3 | 5845 HACIENDA AVENUE LINCOLN CITY, OR 97367 | AFLAC | $75 | $19 | $94 | 0.33% |
| MARC DANIEL BRODEUR3 | 1094 LAURELRIDGE STREET NE KEIZER, OR 97303 | AFLAC | $55 | — | $55 | 0.20% |
| DAVID J MCCLELLAN3 Filed as: DAVID JOHN HANNANT | 14830 NE 167TH STREET WOODINVILLE, WA 98072 | AFLAC | $55 | — | $55 | 0.20% |
| CHERYL DOWNING3 | 496 INVERNESS DR SE SALEM, OR 97306 | AFLAC | $54 | — | $54 | 0.19% |
| WILLIAM R MEDITZ3 | 25884 SW CANYON CREEK ROAD APT J202 WILSONVILLE, OR 97070 | AFLAC | $53 | — | $53 | 0.19% |
| CAROLYN LENARD3 | 3742 LOLO PASS WAY NE APT 106 SALEM, OR 97305 | AFLAC | $50 | — | $50 | 0.18% |
| LARRI B WHEELER3 | 81640 LOST VALLEY LN DEXTER, OR 97431 | AFLAC | $42 | — | $42 | 0.15% |
| JAMES F TUOR3 | 22416 N ARRELLAGA DR SUN CITY WEST, AZ 85375 | AFLAC | $41 | — | $41 | 0.15% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 718B W FOURTH PLAIN BLVD VANCOUVER, WA 98660 | AFLAC | $36 | — | $36 | 0.13% |
| ALICIA J MATSON3 | 6027 ROLLETTI DR SE SALEM, OR 97306 | AFLAC | $32 | — | $32 | 0.11% |
| DAVID FRANSEN3 | 131 65TH PL SPRINGFIELD, OR 97478 | AFLAC | $16 | — | $16 | 0.06% |
| MICHAEL C WALKER3 Filed as: MICHAEL L ALLEY | 2189 SE 12TH AVE CANBY, OR 97013 | AFLAC | $8 | — | $8 | 0.03% |
| ANDRIA R. KINYON3 Filed as: ANDRIA R KINYON | 10990 WAYPARK DR NE SALEM, OR 97305 | AFLAC | $6 | — | $6 | 0.02% |
| 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% |
| JOSEPH P TYRRELL3 | 468 E FOREST RIDGE DR MERIDIAN, ID 83642 | AFLAC | $0 | — | $0 | 0.00% |
| GUY R SOUTER3 | PO BOX 1283 LA PINE, OR 97739 | AFLAC | $0 | — | $0 | 0.00% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: NIEDERMEYER RISK MANAGEMENT | 9340 SW BEAVERTON HILLSDALE HWY. SUITE A BEAVERTON, OR 97005 | METROPOLITAN LIFE INSURANCE COMPANY | $967 | $21 | $988 | — |
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 | 215 | 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) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MODA HEALTH | 317 | $1.2M |
| Dental(2 contracts, 2 carriers) | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 288 | $108K |
| Vision | MODA HEALTH | 317 | $1.2M |
| Other | AFLAC | 31 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 317 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.