| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FREDERICK FISCHER3 | MONTGOMERY AND GRAHAM PO BOX 12888 SALEM, OR 97309 | PROVIDENCE HEALTH PLAN | $23K | — | $23K | 2.15% |
| JASON BEYROUTY3 | ALDRICH BENEFITS 680 HAWTHORNE AVE #140 SALEM, OR 97301 | PROVIDENCE HEALTH PLAN | $11K | — | $11K | 0.99% |
| MONTGOMERY & GRAHAM INC3 | 412 JEFFERSON PKWY STE 100 LAKE OSWEGO, OR 97035 | HARTFORD LIFE AND ACCIDENT | $10K | — | $10K | 5.67% |
| ALDRICH BENEFITS LP3 Filed as: ALDRICH BENEFITS, LP | 680 HAWTHORNE AVE SE STE #140 SALEM, OR 97301 | HARTFORD LIFE AND ACCIDENT | $7K | — | $7K | 3.90% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY AND GRAHAM INC | PO BOX 12888 SALEM, OR 973090888 | AMERITAS LIFE INSURANCE CORP | $2K | — | $2K | 3.19% |
| ALDRICH BENEFITS LP3 | 680 HAWTHORNE AVE SE STE #140 SALEM, OR 973010041 | AMERITAS LIFE INSURANCE CORP | $868 | — | $868 | 1.81% |
| MONTGOMERY & GRAHAM INC3 | 412 JEFFERSON PKY STE 100 LAKE OSWEGO, OR 97035 | LIFEMAP ASSURANCE COMPANY | $408 | — | $408 | 3.00% |
| ALDRICH BENEFITS LP3 Filed as: ALDRICH BENEFITS, LP | 680 HAWTHORNE AVE SE STE #140 SALEM, OR 97301 | LIFEMAP ASSURANCE COMPANY | $274 | — | $274 | 2.01% |
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 | 243 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 245 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 159 | $1.1M |
| Dental(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP | 138 | $95K |
| Vision | LIFEMAP ASSURANCE COMPANY | 130 | $14K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 143 | $174K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 143 | $174K |
| Other | HARTFORD LIFE AND ACCIDENT | 143 | $174K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 159 | — |
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.