| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MONTGOMERY & GRAHAM INC3 | 412 JEFFERSON PARKWAY STE 100 LAKE OSWEGO, OR 97035 | PROVIDENCE HEALTH PLANS | $10K | — | $10K | 2.46% |
| GCG FINANCIAL LLC3 Filed as: DAVIDSON BENEFITS ALERA GROUP | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | PROVIDENCE HEALTH PLANS | $3K | — | $3K | 0.65% |
| MONTGOMERY & GRAHAM INC3 | 412 JEFFERSON PKWY STE 100 LAKE OSWEGO, OR 97035 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $27 | $3K | 8.57% |
| GCG FINANCIAL LLC3 Filed as: DAVIDSON BENEFITS ALERA GROUP | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | METROPOLITAN LIFE INSURANCE COMPANY | $593 | — | $593 | 1.96% |
| POLESTAR BENEFITS INC3 | 412 JEFFERSON PKWY STE 202 LAKE OSWEGO, OR 97035 | METROPOLITAN LIFE INSURANCE COMPANY | $450 | — | $450 | 1.48% |
| MONTGOMERY & GRAHAM INC3 | 412 JEFFERSON PARKWAY LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $550 | $1 | $551 | 9.58% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $222 | $22 | $244 | 4.24% |
| PREMIER WORKSITE SOLUTIONS INC3 | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $45 | $7 | $52 | 0.90% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PROVIDENCE EMPLOYEE ASSISTANCE PROG EIN 93-0823489 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | 4400 NE HALSEY BLDG 1 PORTLAND, OR 97213 | $1K |
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 | 104 | 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) | 104 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLANS | 105 | $407K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 96 | $30K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 96 | $36K |
| Prescription drug | PROVIDENCE HEALTH PLANS | 105 | $407K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 96 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 105 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.