| 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 | $5K | $109 | $5K | 2.83% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM | 412 JEFFERSON PARKWAY #100 LAKE OSWEGO, OR 97035 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $2K | — | $2K | 4.43% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM, INC. | 412 JEFFERSON PKWY. STE. 100 LAKE OSWEGO, OR 970351252 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | $52 | $1K | 14.47% |
| CAMPBELL GALT AND NEWLANDS, INC.3 Filed as: CAMPBELL GAIT AND NEWLANDS, INC. | 700 NE MULTNOMAH STE. 1300 PORTLAND, OR 97232 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $140 | $181 | $321 | 5.28% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVE. LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $222 | $87 | $309 | 5.09% |
| KAREN CLAY KUNKLER3 | 1709 NW 45TH AVENUE CAMAS, WA 98607 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $263 | $33 | $296 | 4.87% |
| HEARTSEASE LLC3 | 1521 NE 63RD AVE. HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $142 | $46 | $188 | 3.10% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | 601 UNION STREET SEATTLE, WA 98101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $151 | $10 | $161 | 2.65% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY AND GRAHAM, INC. | 412 JEFFERSON PKWY. LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $153 | $2 | $155 | 2.55% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH ST. VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $109 | $40 | $149 | 2.45% |
| CHRISTINE LYNN MORGESTER3 | 2137 N. Q ST. WASHOUGAL, WA 98671 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $114 | $28 | $142 | 2.34% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN, INC. | 2101 NE 279TH ST. RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $51 | $15 | $66 | 1.09% |
| SUSAN J LEACH3 Filed as: SUSAN J. LEACH | 4419 NE 131ST PLACE PORTLAND, OR 97230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.30% |
| ZINA OSTER3 | 3153 FOREST DR. CHEYENNE, WY 82001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.12% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM BENEFITS | 412 JEFFERSON PARKWAY #100 LAKE OSWEGO, OR 97035 | EYEMED VISION CARE | $539 | — | $539 | 10.30% |
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 | 143 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 104 | $229K |
| Dental | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 91 | $48K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 143 | $7K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 143 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 143 | — |
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.