| 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 | $10K | — | $10K | 0.98% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFEWISE HEALTH PLAN OF OREGON INC | $11K | — | $11K | 1.30% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 2.50% |
| MATTECHECK & ASSOCIATES3 | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 2.50% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 5.00% |
| MATTECHECK & ASSOCIATES3 | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 5.00% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 7.14% |
| MATTECHECK & ASSOCIATES3 | 610 SW ALDER ST STE 310 PORTLAND, OR 97205 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 7.14% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFEWISE HEALTH PLAN OF OREGON EIN 93-0931709 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $876K |
| VIVACITY EIN 26-4402130 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $58K |
| INTEGRATED BEHAVORIAL HEALTH EIN 33-0851349 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $42K |
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 | 2,092 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 30 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 89 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,211 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | LIFEWISE ASSURANCE COMPANY | 2,116 | $1.9M |
| Dental | LIFEWISE HEALTH PLAN OF OREGON INC | 1,344 | $883K |
| Vision | VISION SERVICE PLAN | 2,134 | $116K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,579 | $290K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 150 | $79K |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 459 | $112K |
| Prescription drug | LIFEWISE HEALTH PLAN OF OREGON INC | 1,344 | $883K |
| Stop-loss / reinsurancereinsurance | LIFEWISE ASSURANCE COMPANY | 2,116 | $1.0M |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,579 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,579 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.