| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BILL LACOUR | 6146 CHURCHILL DOWNS DR WEST LINN, OR 97068 | PROVIDENCE HEALTH PLAN | $40K | — | $40K | 0.38% |
| BILL LACOUR | 6146 CHURCHILL DOWNS DR WEST LINN, OR 97068 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $74K | $6K | $80K | 1.15% |
| BILL LACOUR | 6146 CHURCHILL DOWNS DR WEST LINN, OR 97068 | HCC LIFE INSUANCE COMPANY | $2K | — | $2K | 9.89% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 TPA | Contract Administrator; Claims processing Service code 12 | 700 NE MULTNOMAH PORTLAND, OR 97232 | $392K |
| CIGNA EIN 93-6021772 MEDICAL MANAGEMENT | Participant communication; Float revenue; Claims processing; Non-monetary compensation; Contract Administrator; Named fiduciary; Other services; Direct payment from the plan Service code 12 | — | $195K |
| MODA HEALTH EIN 93-0438772 DENTAL ADMIN FEE | Claims processing Service code 12 | 601 SW SECOND AVE PORTLAND, OR 97204 | $143K |
| MILLER NASH GRAHAM & DUNN LLP EIN 93-0410518 LEGAL COUNSEL | Legal; Direct payment from the plan Service code 29 | 111 SW 5TH AVE. PORTLAND, OR 97201 | $59K |
| MCMORGAN & CO. EIN 52-2334338 INVESTMENT MANAGER | Investment management fees paid directly by plan Service code 51 | 4900 SW GRIFFITH DRIVE BEAVERTON, OR 98005 | $55K |
| US BANK EIN 93-0571729 CUSTODIAN | Custodial (securities); Trustee (bank, trust company, or similar financial institution) Service code 19 | 555 SW OAK STREET PORTLAND, OR 97208 | $48K |
| VISION SERVICE PLAN EIN 06-1227840 VISION ADMIN FEE | Claims processing Service code 12 | 7400 GAYLORD PARKWAY FRISCO, TX 75034 | $29K |
| LINDQUIST LLP EIN 52-2385296 CONTRIBUTION COMPLIANCE | Accounting (including auditing) Service code 10 | 9955 SE WASHINGTON ST20 PORTLAND, OR 97216 | $28K |
| METRO PRESORT INC EIN 93-0799990 COPYING & PRINTING | Copying and duplicating Service code 36 | 3506 NW 35TH AVENUE PORTLAND, OR 97210 | $18K |
| BJORKLUND & MONTPLAISIR EIN 93-1015766 AUDITOR | Accounting (including auditing) Service code 10 | 9020 SW WASHINGTON SQ RD PORTLAND, OR 97223 | $16K |
| WILLIAM LACOUR LLC EIN 46-3675103 INSURANCE BROKER | Insurance brokerage commissions and fees; Consulting (general) Service code 16 | 6146 CHURCHILL DOWNS DR WEST LINN, OR 97068 | $0 |
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 | 1,676 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 634 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,310 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PROVIDENCE HEALTH PLAN | 2,442 | $17.6M |
| Life insurance | HCC LIFE INSUANCE COMPANY | 740 | $17K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSUANCE COMPANY | 740 | $763K |
| Other | HCC LIFE INSUANCE COMPANY | 740 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,442 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.