| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT FOSTER3 | P.O. BOX 8 LEBANON, OR 97355 | PROVIDENCE HEALTH PLAN | $19K | — | $19K | 2.76% |
| RHODES WARDEN INS AGCY3 | PO BOX 8 LEBANON, OR 97355 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 2.97% |
| TIFFANY M HEBERT3 | 567 SOUTHEAST CYPRESS AVENUE DALLAS, OR 97338 | AFLAC | $2K | $232 | $2K | 6.86% |
| RHODES WARDEN INS AGCY3 Filed as: RHODES-WARDEN INSURANCE, INC. | PO BOX 8 LEBANON, OR 97355 | AFLAC | $1K | — | $1K | 3.96% |
| ALICIA J MATSON3 | 3295 TRIANGLE DRIVE SOUTHEAST SUITE 100 SALEM, OR 97302 | AFLAC | $366 | $33 | $399 | 1.34% |
| MARCI MARIE OTIS3 | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $318 | $19 | $337 | 1.13% |
| VINCENT BRIAN VOLLMAR3 | 5885 MEADOWS ROAD SUITE 320 LAKE OSWEGO, OR 97035 | AFLAC | $262 | $27 | $289 | 0.97% |
| JOYCE ANN HARRER3 | 8555 NORTHEAST DOG RIDGE ROAD NEWBERG, OR 97132 | AFLAC | $251 | — | $251 | 0.84% |
| ROBERT ALLEN WHEELER3 | 645 NORTHWEST EVE DRIVE DALLAS, OR 97338 | AFLAC | $231 | — | $231 | 0.77% |
| THERESA LYNN HANE3 | PO BOX 2996 LA PINE, OR 97739 | AFLAC | $188 | — | $188 | 0.63% |
| ABIGAIL BAUGHMAN3 | 38484 SHELBURN DRIVE SCIO, OR 97374 | AFLAC | $129 | $29 | $158 | 0.53% |
| PAUL GLOBAL BENEFITS INC3 Filed as: PAUL MICHAEL HANNANT | 6052 SAWGRASS STREET SOUTHEAST SALEM, OR 97306 | AFLAC | $128 | $23 | $151 | 0.51% |
| JOSEPH P TYRRELL3 | 468 EAST FOREST RIDGE DRIVE MERIDIAN, ID 83642 | AFLAC | $88 | — | $88 | 0.30% |
| RAYMON P KEECH III3 | 8207 CAMPAIGN CIRCLE RICHMOND, TX 77406 | AFLAC | $74 | $2 | $76 | 0.25% |
| MARK A MCRAE3 | 375 NORTHEAST SOUTH NEBERGALL LOOP ALBANY, OR 97321 | AFLAC | $74 | — | $74 | 0.25% |
| JOSHUA ANDERSON3 | 1341 NORTH 16TH STREET MONMOUTH, OR 97361 | AFLAC | $70 | — | $70 | 0.23% |
| PAULA LYNN BIRCHFIELD3 | 1585 WAVERLY DRIVE SOUTHEAST APARTMENT 101 ALBANY, OR 97322 | AFLAC | $44 | — | $44 | 0.15% |
| NATHAN HANSEN3 | 745 EAST DUSTY CREEK AVENUE SANDY, UT 84094 | AFLAC | $24 | $4 | $28 | 0.09% |
| ZINA SHADRIN3 | PO BOX 1704 LAKE OSWEGO, OR 97035 | AFLAC | $25 | — | $25 | 0.08% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 718B WEST FOURTH PLAIN BOULEVARD VANCOUVER, WA 98660 | AFLAC | $18 | — | $18 | 0.06% |
| PAULLA ANN WALKER3 | 601 IDYLWOOD DRIVE SOUTHEAST SALEM, OR 97302 | AFLAC | $10 | — | $10 | 0.03% |
| TREVOR WILKS3 | 722 HIGHLAND AVENUE NORTHEAST SALEM, OR 97301 | AFLAC | $5 | $1 | $6 | 0.02% |
| DAVID J MCCLELLAN3 Filed as: DAVID JOHN HANNANT | 14830 NORTHEAST 167TH STRET WOODINVILLE, WA 98072 | AFLAC | $5 | — | $5 | 0.02% |
| DEREK SOMMERS3 | 518 NORTH 39TH PLACE RIDGEFIELD, WA 98642 | AFLAC | $3 | — | $3 | 0.01% |
| G SCOTT COOKE3 Filed as: SCOTT E NIELSEN | 2709 DAY ISLAND BOULEVARD WEST UNIT A UNIVERSITY PLACE, WA 98466 | AFLAC | $2 | — | $2 | 0.01% |
| MATTHEW G BERGER3 Filed as: MATTHEW A BUMALA | 14415 NORTHWEST 25TH COURT VANCOUVER, WA 98685 | AFLAC | $1 | — | $1 | 0.00% |
| RHODES WARDEN INS AGCY3 | PO BOX 8 LEBANON, OR 97355 | STANDARD INSURANCE COMPANY | $668 | — | $668 | 6.56% |
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 | 117 | 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) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 115 | $676K |
| Dental | STANDARD INSURANCE COMPANY | 113 | $70K |
| Life insurance | STANDARD INSURANCE COMPANY | 120 | $10K |
| Other(2 contracts, 2 carriers) | AFLAC | 120 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 120 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.