| 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 | $20K | $71 | $20K | 2.99% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM, INC. | 412 JEFFERSON PKWY. STE. 100 LAKE OSWEGO, OR 970351252 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | — | $6K | 6.33% |
| POLESTAR BENEFITS INC3 Filed as: POLESTAR BENEFITS, INC. | 412 JEFFERSON PKWY. STE. 202 LAKE OSWEGO, OR 970351252 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 2.84% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY AND GRAHAM, INC. | 412 JEFFERSON PKWY. LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $7 | $2K | 9.03% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH ST. VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $310 | $2K | 5.57% |
| ROXANA BUSCHMAN3 | 400 NORTHEAST 149TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $67 | $1K | 5.23% |
| DEREK THURSTON3 | 112 NW 114TH ST. VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $263 | $2 | $265 | 0.98% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH ST. RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $63 | $13 | $76 | 0.28% |
| VOLUNTARY BENEFITS SOL LLC3 Filed as: VOLUNTARY BENEFIT SOLUTIONS, INC. | 718 W. FOURTH PLAIN BLVD. VANCOUVER, WA 98660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $63 | — | $63 | 0.23% |
| MARGARET BRYANT3 Filed as: MARGARET BRYAN | 18014 SW BELMORE AVE. LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $50 | $10 | $60 | 0.22% |
| ZINA OSTER3 | 3153 FOREST DR. CHEYENNE, WY 82001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $35 | — | $35 | 0.13% |
| SUSAN J LEACH3 Filed as: SUSAN J. LEACH | 4419 NE 131ST PLACE PORTLAND, OR 97230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.03% |
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. |
| 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 | 148 | $685K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 266 | $100K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 266 | $127K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 266 | $127K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 266 | — |
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.