| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 318 BOTHELL, WA 98041 | UNITEDHEALTHCARE INSURANCCE COMPANY | $1K | $26K | $28K | 2.86% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1411 OPUS PLACE, SUITE 450 DOWNERS GROVE, IL 60515 | UNITEDHEALTHCARE INSURANCCE COMPANY | $0 | $435 | $435 | 0.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 400 GALLERIA PARKWAY, SUITE 300 ATLANTA, GA 30339 | OREGON DENTAL SERVICES DBA DELTA DENTAL PLAN OF OREGON | $3K | $0 | $3K | 3.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 2329 LAKE OSWEGO, OR 97035 | AFLAC | $4K | $0 | $4K | 9.26% |
| JOSEPH P CALARCO3 Filed as: JOSEPH PATRICK FOXLEY | 2660 RAINER PLACE WEST LINN, OR 97068 | AFLAC | $2K | $147 | $2K | 4.15% |
| L & T ENT LLC3 Filed as: L & T ENT LLC AND OTHER AGENTS | 2441 IMPERIAL DRIVE NW ALBANY, OR 97321 | AFLAC | $2K | $52 | $2K | 3.96% |
| STEPHANIE JOELAINE THOMAS ROID3 | 780 NW GARDEN VALLEY BOULEVARD SUITE 64 ROSEBURG, OR 67471 | AFLAC | $1K | $0 | $1K | 2.20% |
| KEVIN WINBORNE3 | 20067 SW 57TH TERRACE TUALATIN, OR 97062 | AFLAC | $720 | $0 | $720 | 1.58% |
| BRYAN G CORBIN LLC3 Filed as: BRYAN G. CORBIN LLC | 6950 SW HAMPTON STREET, SUITE 260 TIGARD, OR 97223 | AFLAC | $553 | $39 | $592 | 1.30% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: EMILY MCLENNAN | 544 WEST 20TH AVENUE EUGENE, OR 97405 | AFLAC | $356 | $0 | $356 | 0.78% |
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 | 81 | 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) | 81 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCCE COMPANY | 186 | $968K |
| Dental | OREGON DENTAL SERVICES DBA DELTA DENTAL PLAN OF OREGON | 122 | $105K |
| Vision | UNITEDHEALTHCARE INSURANCCE COMPANY | 186 | $968K |
| Prescription drug | UNITEDHEALTHCARE INSURANCCE COMPANY | 186 | $968K |
| Other | AFLAC | 67 | $46K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 186 | — |
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.