| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FRED FISCHER3 | MONTGOMERY AND GRAHAM INC PO BOX 12888 SALEM, OR 97309 | PROVIDENCE HEALTH PLAN | $31K | — | $31K | 2.76% |
| MONTGOMERY & GRAHAM INC3 | 412 JEFFERSON PKWY STE 100 LAKE OSWEGO, OR 97035 | HARTFORD LIFE AND ACCIDENT | $16K | $488 | $17K | 11.11% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY AND GRAHAM CONSULTING | 412 JEFFERSON PKY STE 100 LAKE OSWEGO, OR 97035 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $3K | — | $3K | 4.45% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY AND GRAHAM CONSULTING | 412 JEFFERSON PKY STE 100 LAKE OSWEGO, OR 97035 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $2K | — | $2K | 4.45% |
| MONTGOMERY & GRAHAM INC3 | 412 JEFFERSON PKY STE 100 LAKE OSWEGO, OR 97035 | LIFEMAP ASSURANCE COMPANY | $683 | — | $683 | 5.02% |
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 | 206 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 209 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 171 | $1.1M |
| Dental(2 contracts) | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 128 | $120K |
| Vision | LIFEMAP ASSURANCE COMPANY | 124 | $14K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 139 | $150K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 139 | $150K |
| Other | HARTFORD LIFE AND ACCIDENT | 139 | $150K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 171 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.