| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM, INC. | 412 JEFFERSON PKWY STE 100 LAKE OSWEGO, OR 97035 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $20K | $1K | $22K | 5.46% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM INC. | 412 JEFFERSON PKWY STE 100 LAKE OSWEGO, OR 97035 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $35 | $3K | $3K | 19.98% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM INC. | 412 JEFFERSON PKWY STE 100 LAKE OSWEGO, OR 97035 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $27 | $2K | 15.24% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM INC. | 412 JEFFERSON PKWY STE 100 LAKE OSWEGO, OR 97035 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $14 | $1K | 15.16% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM INC. | 412 JEFFERSON PKWY STE 100 LAKE OSWEGO, OR 97035 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $17 | $2K | 19.88% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM INC. | 412 JEFFERSON PKWY STE 100 LAKE OSWEGO, OR 97035 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $350 | $14 | $364 | 10.40% |
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 | 112 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 92 | $396K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $19K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 49 | $8K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 43 | $11K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 112 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.