| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: EDWIN J. TEDERS & VARIOUS AGENTS | 1345 183RD AVENUE NORTHEAST BELLEVUE, WA 98008 | AFLAC | $860 | $0 | $860 | 4.38% |
| CRYSTAL ANN MCCARTHY3 | 2715 SOUTHWEST 31ST STREET GRESHAM, OR 97080 | AFLAC | $806 | $34 | $840 | 4.28% |
| WILLIAM JAMES MCPHEE3 | 20332 SOUTHWEST ERIN PLACE ALOHA, OR 97003 | AFLAC | $651 | $0 | $651 | 3.31% |
| BONNIE LOUESE MCCREERY3 | 524 LAUREL STREET LAKE OSWEGO, OR 97034 | AFLAC | $282 | $0 | $282 | 1.44% |
| ANGEL X ESCAMILLA3 Filed as: ANGEL X. ESCAMILLA | 4920 SOUTHWEST LOMBARD AVENUE BEAVERTON, OR 97005 | AFLAC | $234 | $8 | $242 | 1.23% |
| JAMES S SARANTIS3 Filed as: JAMES S. SARANTIS | 14132 SOUTHEAST FIRCREST COURT PORTLAND, OR 97236 | AFLAC | $141 | $8 | $149 | 0.76% |
| VALORIE R. SMITH3 | 6248 WEST COHIBA LANE BOISE, ID 83703 | AFLAC | $143 | $0 | $143 | 0.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | UNKNOWN WILSONVILLE, OR 97070 | WILLAMETTE DENTAL INSURANCE, 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 | 196 | 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) | 196 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | WILLAMETTE DENTAL INSURANCE, INC. | 32 | $17K |
| Vision | AFLAC | 39 | $20K |
| Life insurance | AFLAC | 39 | $20K |
| Short-term disability | AFLAC | 39 | $20K |
| Other | AFLAC | 39 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 39 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.