| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BILL LACOUR | 6146 CHURCHILL DOWNS DR WEST LINN, OR 97068 | PROVIDENCE HEALTH PLAN | $40K | — | $40K | 0.40% |
| BILL LACOUR | 6146 CHURCHILL DOWNS DR WEST LINN, OR 97068 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $67K | $6K | $73K | 1.11% |
| BILL LACOUR | 6146 CHURCHILL DOWNS DR WEST LINN, OR 97068 | HCC LIFE INSUANCE COMPANY | $2K | — | $2K | 10.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 TPA | Contract Administrator Service code 13 | 700 NE MULTNOMAH PORTLAND, OR 97232 | $442K |
| CIGNA EIN 93-6021772 MEDICAL MANAGEMENT | Non-monetary compensation; Other services; Float revenue; Participant communication; Contract Administrator; Direct payment from the plan; Named fiduciary; Claims processing Service code 12 | 8505 EAST ORCHARDROAD,5E8 GREENWOOD VILLAGE, CO 80111 | $334K |
| MODA HEALTH EIN 93-0438772 DENTAL ADMIN FEE | Claims processing Service code 12 | 601 SW SECOND AVE PORTLAND, OR 97204 | $167K |
| 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 | $109K |
| US BANK EIN 93-0571729 CUSTODIAN | Trustee (bank, trust company, or similar financial institution); Custodial (securities) Service code 19 | 555 SW OAK STREET PORTLAND, OR 97208 | $51K |
| LINDQUIST LLP EIN 52-2385296 CONTRIBUTION COMPLIANCE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 9955 SE WASHINGTON ST20 PORTLAND, OR 97216 | $32K |
| VISION SERVICE PLAN EIN 06-1227840 VISION ADMIN FEE | Claims processing Service code 12 | 7400 GAYLORD PARKWAY FRISCO, TX 75034 | $32K |
| VERUS ADVISORY, INC. EIN 91-1320111 INVESTMENT ADVISOR | Consulting (pension); Direct payment from the plan; Investment advisory (plan) Service code 17 | PO BOX 303 TUALATIN, OR 97062 | $30K |
| BJORKLUND & MONTPLAISIR EIN 93-1015766 AUDITOR | Accounting (including auditing) Service code 10 | 9020 SW WASHINGTON SQ RD PORTLAND, OR 97223 | $16K |
| METRO PRESORT INC EIN 93-0799990 COPYING & PRINTING | Copying and duplicating Service code 36 | 3506 NW 35TH AVENUE PORTLAND, OR 97210 | $12K |
| PAUL C. HAYS ATTORNEY EIN 47-3252661 LEGAL COUNSEL | Legal Service code 29 | 10300 SW GREENBURG ROAD PORTLAND, OR 97223 | $11K |
| KROGER PRESCRIPTION PLAN EIN 20-5927634 RDS RX ADVISOR | Claims processing Service code 12 | PO BOX 14002 ROANOKE, VA 24038 | $9K |
| MILLIMAN USA EIN 91-0675641 ACTUARIAL SERVICES | Direct payment from the plan; Actuarial Service code 11 | 111 SW 5TH AVE. PORTLAND, OR 97204 | $8K |
| KAYE-SMITH EIN 93-0523003 COPYING & PRINTING | Copying and duplicating Service code 36 | 4101 OAKESDAKE AVE SW RENTON, WA 98057 | $6K |
| RENICK PRINTING INC EIN 91-1475317 COPYING & PRINTING | Copying and duplicating Service code 36 | 23121 EDMONDS WAY EDMONDS, WA 98020 | $6K |
| 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 | 1,906 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 621 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,527 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PROVIDENCE HEALTH PLAN | 1,818 | $16.7M |
| Life insurance | HCC LIFE INSUANCE COMPANY | 823 | $16K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSUANCE COMPANY | 823 | $808K |
| Other | HCC LIFE INSUANCE COMPANY | 823 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,818 | — |
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.