| 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 | $27K | $1K | $28K | 3.08% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM, INC | 412 JEFFERSON PKWY STE 100 LAKE OSWEGO, OR 97035 | PRINCIPAL LIFE INSURANCE COMPANY | $12K | $3K | $15K | 10.48% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM, INC. | 412 JEFFERSON PKWY #100 LAKE OSWEGO, OR 97035 | MEDICAL EYE SERVICES OF OREGON, INC. | $2K | $0 | $2K | 10.00% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY AND GRAHAM INC | 412 JEFFERSON PKWY LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $939 | $293 | $1K | 15.87% |
| MARGARET BRYANT3 | 18014 SW BELMORE AVE LAKE OSWEGO, OR 97035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $500 | $219 | $719 | 9.26% |
| PREMIER WORKSITE SOLUTIONS INC3 | 112 NW 114TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $69 | $50 | $119 | 1.53% |
| THOMAS TAYLOR3 Filed as: THOMAS MCKY TAYLOR | PO BOX 70334 SPRINGFIELD, OR 97475 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $95 | $0 | $95 | 1.22% |
| ZINA OSTER3 | 3153 FOREST DR CHEYENNE, WY 82001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | $0 | $13 | 0.17% |
| DAMON RAY OGIER3 | 1630 CARNAHAN DR #5 GRANTS PASS, OR 97527 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
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 | 228 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 228 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 332 | $924K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 317 | $196K |
| Vision | MEDICAL EYE SERVICES OF OREGON, INC. | 99 | $16K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 317 | $142K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 317 | $142K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 317 | $142K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 17 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 332 | — |
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."
No prospect flags tripped on this filing.