| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFEWISE ASSURANCE COMPANY | $4K | — | $4K | 0.47% |
| MATTECHECK & ASSOCIATES3 | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $3K | $7K | 4.51% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 2.50% |
| MATTECHECK & ASSOCIATES3 | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $1K | $5K | 7.11% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 5.00% |
| MATTECHECK & ASSOCIATES3 | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 2.04% |
| MATTECHECK & ASSOCIATES3 | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 2.01% |
| MATTECHECK & ASSOCIATES3 | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $308 | $308 | 2.01% |
| MATTECHECK & ASSOCIATES3 | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $963 | $280 | $1K | 8.72% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $963 | — | $963 | 6.75% |
| MATTECHECK & ASSOCIATES3 | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $299 | $1K | 9.63% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 7.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| VIVACITY EIN 26-4402130 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $123K |
| INFINISOURCE INC EIN 38-2976613 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 15 E WASHINGTON ST COLDWATER, MI 49036 | $41K |
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 | 3,032 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 24 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,056 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | LIFEWISE HEALTH PLAN OF OREGON INC | 676 | $819K |
| Dental(2 contracts) | LIFEWISE HEALTH PLAN OF OREGON INC | 676 | $819K |
| Vision | VISION SERVICE PLAN | 2,067 | $119K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,561 | $217K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 86 | $68K |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 433 | $79K |
| Prescription drug(2 contracts) | LIFEWISE HEALTH PLAN OF OREGON INC | 676 | $819K |
| Stop-loss / reinsurancereinsurance | LIFEWISE ASSURANCE COMPANY | 2,043 | $939K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,561 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,561 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.