| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MATTECHECK & ASSOCIATES3 Filed as: MATTECHECK AND ASSOCIATES | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $1K | $8K | 11.86% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFIT MGMT SERVICES INC EIN 81-0391256 TPA | Contract Administrator Service code 13 | — | $102K |
| QUEST DIAGNOSTICS EIN 38-2084239 LAB DIAGNOSTICS | Other fees Service code 99 | — | $43K |
| EMPLOYEE BENEFIT MGMT SERVICES, INC EIN 81-0391256 DISEASE MANAGEMENT | Other fees Service code 99 | — | $28K |
| DCC INC EIN 22-3857341 DIALYSIS COST | Other insurance fees and expenses Service code 73 | — | $28K |
| MINES & ASSOCIATES EIN 84-1028610 EAP | Other fees Service code 99 | — | $7K |
| FIRST HEALTH GROUP EIN 20-1736437 PPO | Other services Service code 49 | — | $6K |
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 | 244 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 17 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 261 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 517 | $68K |
| Prescription drug | BENCHMARK INSURANCE CO | 517 | $387K |
| Stop-loss / reinsurancereinsurance | BENCHMARK INSURANCE CO | 517 | $387K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 517 | $68K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 517 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.