| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AKT BENEFIT ADVISORS LP3 | 5665 SW MEADOWS ROAD, SUITE 200 LAKE OSWEGO, OR 97035 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | — | $1K | $1K | 0.56% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | LIFEMAP ASSURANCE COMPANY | $3K | $1K | $4K | 16.98% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 600 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | LIFEMAP ASSURANCE COMPANY | $540 | — | $540 | 2.16% |
| JAMES WEIL3 | 3147 LAKEVIEW PLACE NW SALEM, OR 97304 | AFLAC | $704 | $43 | $747 | 6.31% |
| VINCENT BRIAN VOLLMAR3 | 3225 CAMELLIA DRIVE SOUTH SALEM, OR 97302 | AFLAC | $250 | $10 | $260 | 2.20% |
| MJ INSURANCE3 Filed as: MICHAEL BERINGER AND VARIOUS AGENTS | 384 ILLINOIS COURT NE SALEM, OR 97301 | AFLAC | $189 | $8 | $197 | 1.66% |
| ALICIA J MATSON3 Filed as: ALICIA J. MATSON | 3295 TRIANGLE DRIVE SE, SUITE 100 SALEM, OR 97302 | AFLAC | $172 | $15 | $187 | 1.58% |
| LYLE D. RODMAN3 | 13900 SE HIGHWAY 212, SUITE 70 CLACKAMAS, OR 97015 | AFLAC | $84 | — | $84 | 0.71% |
| JAMES F TUOR3 Filed as: JAMES F. TUOR | 1370 TIBURON COURT SE SALEM, OR 97302 | AFLAC | $37 | — | $37 | 0.31% |
| CAROLYN LENARD3 | 3742 LOLO PASS WAY NE APARTMENT 106 SALEM, OR 97305 | AFLAC | $26 | — | $26 | 0.22% |
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 | 148 | 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) | 148 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 43 | $179K |
| Dental | WILLAMETTE DENTAL INSURANCE, INC. | 93 | $34K |
| Life insurance(2 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 148 | $37K |
| Short-term disability | AFLAC | 16 | $12K |
| Long-term disability | LIFEMAP ASSURANCE COMPANY | 148 | $25K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 43 | $179K |
| Other | LIFEMAP ASSURANCE COMPANY | 148 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 148 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.