| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PCF INSURANCE SERVICES OF THE WEST3 | 412 JEFFERSON PARKWAY SUITE 203 LAKE OSWEGO, OR 97035 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | — | $417 | $417 | 0.08% |
| PCF INSURANCE SERVICES OF THE WEST3 | 412 JEFFERSON PARKWAY SUITE 203 LAKE OSWEGO, OR 97035 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $527 | $4 | $531 | 0.35% |
| MONTGOMERY & GRAHAM INC3 | 412 JEFFERSON PARKWAY SUITE 203 LAKE OSWEGO, OR 97035 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 7.27% |
| PCF INSURANCE SERVICES OF THE WEST3 | 412 JEFFERSON PARKWAY SUITE 203 LAKE OSWEGO, OR 97035 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 2.73% |
| MONTGOMERY & GRAHAM INC3 | 412 JEFFERSON PARKWAY SUITE 203 LAKE OSWEGO, OR 97035 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $740 | — | $740 | 7.25% |
| PCF INSURANCE SERVICES OF THE WEST3 | 412 JEFFERSON PARKWAY SUITE 203 LAKE OSWEGO, OR 97035 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $281 | — | $281 | 2.75% |
| PCF INSURANCE SERVICES OF THE WEST3 | 412 JEFFERSON PARKWAY SUITE 203 LAKE OSWEGO, OH 97035 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $589 | — | $589 | 8.14% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM BENEFITS | 412 JEFFERSON PARKWAY #100 LAKE OSWEGO, OR 97035 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $198 | — | $198 | 2.73% |
| MARGARET BRYANT3 | 18014 SOUTHWEST BELMORE AVENUE LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $334 | $114 | $448 | 13.74% |
| KAREN CLAY KUNKLER3 | 415 SOUTHEAST 177TH AVENUE UNIT 236 VANCOUVER, WA 98683 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $323 | $54 | $377 | 11.56% |
| PCF INSURANCE SERVICES OF THE WEST3 | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $214 | — | $214 | 6.56% |
| WORKSITE BENEFITS GROUP INC3 | 112 NORTHWEST 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $72 | $142 | $214 | 6.56% |
| ISAACSON INSURANCE AGENCY LLC3 | 1250 11TH STREET WEST LINN, OR 97068 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | $8 | $32 | 0.98% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAN INC | 412 JEFFERSON PARKWAY LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | — | $23 | 0.71% |
| HEARTSEASE LLC3 | 1521 NORTHEAST 63RD AVENUE HILLSBORO, OR 97124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | — | $22 | 0.67% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | 601 UNION STREET SEATTLE, WA 98101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | — | $20 | 0.61% |
| CHRISTINE LYNN MORGESTER3 | 14913 SOUTH SUNTERRA LOOP OREGON CITY, OR 97045 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.12% |
| ZINA OSTER3 | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.09% |
| BENEFITS BY DESIGN INC3 | 2101 NORTHEAST 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.06% |
| MONTGOMERY & GRAHAM INC3 | 412 JEFFERSON PARKWAY SUITE 203 LAKE OSWEGO, OR 97035 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $193 | — | $193 | 7.15% |
| PCF INSURANCE SERVICES OF THE WEST3 | 412 JEFFERSON PARKWAY SUITE 203 LAKE OSWEGO, OR 97035 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $77 | — | $77 | 2.85% |
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 | 126 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 125 | $673K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 88 | $42K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 103 | $7K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $13K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 2 | $3K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 127 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.