| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $3K | $3K | 1.04% |
| TAMARA MARIE QUARRY3 | 5250 HARDING LANE SE TURNER, OR 97392 | AFLAC | $3K | $235 | $4K | 7.42% |
| TREVOR WILKS3 | 722 HIGHLAND AVENUE NE SALEM, OR 97301 | AFLAC | $2K | $55 | $2K | 3.29% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: NEIDERMEYER RISK MANAGEMENT LLC | 9340 SW BEAVERTON HILLSIDE HWY SUITE A BEAVERTON, OR 97005 | AFLAC | $1K | $0 | $1K | 2.14% |
| VINCENT BRIAN VOLLMAR3 | 777 COMMERCIAL STREET SE SUITE 20 SALEM, OR 97301 | AFLAC | $937 | $55 | $992 | 2.00% |
| PAULLA ANN WALKER3 | 601 IDYLWOOD DRIVE SE SALEM, OR 97302 | AFLAC | $662 | $0 | $662 | 1.33% |
| MJ INSURANCE3 Filed as: MJI INC & VARIOUS AGENTS | PO BOX 847 MCMINNVILLE, OR 97128 | AFLAC | $364 | $0 | $364 | 0.73% |
| ANDREW N LUCCOCK3 Filed as: ANDREW N. LUCCOCK | 23984 SOUTHWEST SHADY GROVE DRIVE SHERWOOD, OR 97140 | AFLAC | $85 | $0 | $85 | 0.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | UNKNOWN SALEM, OR 97303 | MEDICAL EYE SERVICES OF OREGON, INC. | $2K | $0 | $2K | 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 | 257 | 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) | 257 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 605 | $242K |
| Vision | MEDICAL EYE SERVICES OF OREGON, INC. | 302 | $20K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 605 | $292K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 605 | $292K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 605 | — |
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.