| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MATTECHECK & ASSOCIATES3 Filed as: MATTECHECK & ASSOCIATES INC | PO BOX 1831 BEAVERTON, OR 97075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 0.55% |
| MATTECHECK & ASSOCIATES3 Filed as: MATTECHECK & ASSOCIATES INC | PO BOX 1831 BEAVERTON, OR 97075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $157 | $3K | 11.58% |
| PATRICK IAN WAGNER3 Filed as: PATRICK I WAGNER | 4580 PEBBLE BROOK LANE PLANO, TX 75093 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 5.24% |
| MATTECHECK & ASSOCIATES3 Filed as: MATTECHECK & ASSOCIATES INC | PO BOX 1831 BEAVERTON, OR 97075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $182 | $2K | 9.26% |
| VIGILANT GROUP, LLC3 Filed as: VIGILANT SERVICES INC | 6825 SW SANDBURG ST TIGARD, OR 97223 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $209 | $22 | $231 | 1.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCOMP ADMINISTRATORS EIN 77-0385729 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $235K |
| FIRST HEALTH EIN 91-1272766 PPO VENDOR | Direct payment from the plan; Other fees Service code 50 | — | $31K |
| MATTECHECK AND ASSOCIATES EIN 93-1130365 BROKER | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $28K |
| INNOVATIVE CARE MANAGEMENT EIN 93-1087669 UR/UM | Direct payment from the plan; Other fees Service code 50 | — | $23K |
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 | 770 | 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) | 775 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QBE INSURANCE | 342 | $268K |
| Life insurance(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 844 | $329K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 844 | $300K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 844 | $277K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 844 | $329K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 844 | — |
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.