| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM INC. | 412 JEFFERSON PARKWAY, SUITE 100 LAKE OSWEGO, OR 97035 | PACIFICSOURCE HEALTH PLANS | $102K | $0 | $102K | 1.34% |
| MONTGOMERY & GRAHAM INC3 Filed as: MONTGOMERY & GRAHAM INC. | 412 JEFFERSON PARKWAY, SUITE 100 LAKE OSWEGO, OR 97035 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $29K | $0 | $29K | 14.17% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP INSURANCE SERVICES INC. | 1250 CAPITAL OF TEXAS HWY SOUTH BUILDING II, SUITE 600 AUSTIN, TX 78746 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $3K | $3K | 1.37% |
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 | 544 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 549 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 1,429 | $7.6M |
| Dental | PACIFICSOURCE HEALTH PLANS | 1,429 | $7.6M |
| Vision | PACIFICSOURCE HEALTH PLANS | 1,429 | $7.6M |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 632 | $203K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 632 | $203K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 632 | $203K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 1,429 | $7.6M |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 632 | $203K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,429 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.