| 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 | $39K | — | $39K | 2.73% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 | PO BOX 9201 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE COMPANY | $17K | $3K | $20K | 18.00% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.66% |
| TAMARA MARIE QUARRY3 | 5250 HARDING LANE SE TURNER, OR 97392 | AFLAC | $8K | $154 | $9K | 19.93% |
| TREVOR WILKS3 | 722 HIGHLAND AVE NE SALEM, OR 97301 | AFLAC | $2K | $32 | $2K | 4.25% |
| VINCENT BRIAN VOLLMAR3 | 777 COMMERCIAL ST SE STE 20 SALEM, OR 97301 | AFLAC | $1K | $39 | $1K | 3.14% |
| PAULLA ANN WALKER3 | 601 IDYLWOOD DR SE SALEM, OR 97302 | AFLAC | $1K | $33 | $1K | 2.94% |
| MJ INSURANCE3 Filed as: MJI INC DBA HAGAN | PO BOX 847 MCMINNVILLE, OR 97128 | AFLAC | $189 | — | $189 | 0.44% |
| DAVID J MCCLELLAN3 Filed as: DAVID JOHN HANNANT | 14830 NE 167TH ST WOODINVILLE, WA 98072 | AFLAC | $54 | — | $54 | 0.13% |
| WILLIAM R MEDITZ3 | 25884 SW CANYON CREEK RD APT J202 WILSONVILLE, OR 97070 | AFLAC | $53 | — | $53 | 0.12% |
| CAROLYN LENARD3 | 3742 LOLO PASS WAY NE APT 106 SALEM, OR 97305 | AFLAC | $44 | — | $44 | 0.10% |
| LARRI B WHEELER3 | 81640 LOST VALLEY LN DEXTER, OR 97431 | AFLAC | $42 | — | $42 | 0.10% |
| JAMES F TUOR3 | 22416 N ARRELLAGA DR SUN CITY WEST, AZ 85375 | AFLAC | $39 | — | $39 | 0.09% |
| MARC DANIEL BRODEUR3 | 880 SE LOCUST ST DUNDEE, OR 97115 | AFLAC | $34 | $4 | $38 | 0.09% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 718B W FOURTH PLAIN BLVD VANCOUVER, WA 98660 | AFLAC | $36 | — | $36 | 0.08% |
| ALICIA J MATSON3 | 6027 ROLLETTI DR SE SALEM, OR 97306 | AFLAC | $30 | — | $30 | 0.07% |
| CHERYL DOWNING3 | 496 INVERNESS DR SE SALEM, OR 97306 | AFLAC | $16 | $3 | $19 | 0.04% |
| PETER JOHN MARTIN3 | 350 13TH ST NE APT 208 SALEM, OR 97301 | AFLAC | $17 | — | $17 | 0.04% |
| DAVID FRANSEN3 | 131 65TH PL SPRINGFIELD, OR 97478 | AFLAC | $16 | — | $16 | 0.04% |
| MICHAEL C WALKER3 Filed as: MICHAEL L ALLEY | 2189 SE 12TH AVE CANBY, OR 97013 | AFLAC | $8 | — | $8 | 0.02% |
| SHAWN NEVIN3 | 5845 HACIENDA AVE LINCOLN CITY, OR 97367 | AFLAC | $7 | — | $7 | 0.02% |
| BEVERLY KAYE PARKHURST3 | PO BOX 21147 KEIZER, OR 97307 | AFLAC | $7 | — | $7 | 0.02% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $3 | — | $3 | 0.01% |
| GLENN D PARKHURST3 | PO BOX 21147 KEIZER, OR 97307 | AFLAC | $3 | — | $3 | 0.01% |
| GINA SIENIA3 | PO BOX 446 ECHO, OR 97826 | AFLAC | $2 | — | $2 | 0.00% |
| BRAD P CHEWNING3 | 26000 HALL RD WILLAMINA, OR 97396 | AFLAC | $1 | — | $1 | 0.00% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: NIEDERMEYER RISK MANAGEMENT | 9340 SW BEAVERTON HILLSDALE HWY. SUITE A BEAVERTON, OR 97005 | MEDICAL EYE SERVICES OF OREGON, INC. | $1K | — | $1K | 10.00% |
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 | 230 | 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) | 230 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MODA HEALTH | 333 | $1.4M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 344 | $114K |
| Vision | MEDICAL EYE SERVICES OF OREGON, INC. | 214 | $12K |
| Other | AFLAC | 39 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 344 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.