| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM, INC. | 412 JEFFERSON PKWY #100 LAKE OSWEGO, OR 97035 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $17K | $1K | $18K | 2.13% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM, INC. | 412 JEFFERSON PKWY #100 LAKE OSWEGO, OR 97035 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | — | $471 | $471 | 0.06% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY AND GRAHAM INC | 412 JEFFERSON PKWY LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | $293 | $5K | 11.01% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVE. LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $1K | $3K | 5.60% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS | 112 NW 114TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $587 | $264 | $851 | 1.79% |
| GABRIEL ANGEL CANALS3 | 1329 NE 236TH AVE WOOD VILLAGE, OR 97060 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $344 | $375 | $719 | 1.51% |
| ROXANA BUSCHMAN3 | 400 NORTHEAST 149TH VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $665 | $30 | $695 | 1.46% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION ST SEATTLE, WA 98101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $209 | — | $209 | 0.44% |
| RAQUEL LOSADA MONROY3 | 814 NE DELP ROAD CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $147 | $27 | $174 | 0.37% |
| GORDON FREDERICK WOLLEN3 | PO BOX 846 CANNON BEACH, OR 97110 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $137 | $7 | $144 | 0.30% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $55 | — | $55 | 0.12% |
| ZINA OSTER3 | 3153 FOREST DR CHEYENNE, WY 82001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $48 | — | $48 | 0.10% |
| KAREN CLAY KUNKLER3 | 1709 NW 45TH AVE CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $44 | — | $44 | 0.09% |
| SUSAN J LEACH3 | 4419 NE 131ST PLACE PORTLAND, OR 97230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.03% |
| JOEL N NEWMAN AGENCY LLC3 Filed as: JOEL N NEWMAN | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.02% |
| ROBERT MORRISON3 | 937 THIMBLEBERRY DR CASTLE ROCK, WA 98029 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.02% |
| LUIS EDUARDO CARDENAS3 | 26341 SE DUTHIE HILL ROAD ISSAQUAH, WA 98611 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY AND GRAHAM INC | 412 JEFFERSON PKWAY LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $302 | $4K | 13.28% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVE LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $1K | $3K | 9.05% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS INC, | 112 NW 114TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $417 | $304 | $721 | 2.51% |
| RAQUEL LOSADA MONROY3 | 817 NE DELP ROAD CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $388 | $71 | $459 | 1.60% |
| GABRIEL ANGEL CANALS3 | 1329 NE 236TH AVE WOOD VILLAGE, OR 97060 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $160 | $173 | $333 | 1.16% |
| ROXANA BUSCHMAN3 | 400 NORTHEAST 149TH VANCOVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $268 | $15 | $283 | 0.99% |
| GORDON FREDERICK WOLLEN3 | P.O. BOX 846 CANNON BEACH, OR 97110 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $145 | $6 | $151 | 0.53% |
| LUIS EDUARDO CARDENAS3 | 26341 SE DUTHIE HILL ROAD ISSAQUAH, WA 98029 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $109 | — | $109 | 0.38% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION ST SEATTLE, WA 98101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $103 | — | $103 | 0.36% |
| LISA LOUISE ROBBERSON3 | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $35 | $1 | $36 | 0.13% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.11% |
| ZINA OSTER3 | 3153 FOREST DR. CHEYENNE, WY 82001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.04% |
| JOEL N NEWMAN AGENCY LLC3 | 12360 LAKE CITY WAY NE SEATTLE, WA 98125 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| SANDRA L AYERS3 | 2119 GULLANE WAY GILROY, CA 95020 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.01% |
| DONALD C SAVOY INC3 Filed as: DONALD TERRY GOTHAM | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| DOUGLAS EDWARD VIESELMEYER3 | 14405 115TH AVE. CT E PUYALLUP, WA 98374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY AND GRAHAM INC | 412 JEFFERSON PKWY SUITE 100 LAKE OSWEGO, OR 97035 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 5.08% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM | 412 JEFFERSON PARKWAY, SUITE 100 LAKE OSWEGO, OR 97035 | MAGELLAN HEALTHCARE | $453 | — | $453 | 12.00% |
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 | 241 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 241 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 241 | $1.2M |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 205 | $24K |
| Life insurance(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 70 | $76K |
| Other(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 120 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 241 | — |
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."
No prospect flags tripped on this filing.