| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BILL LACOUR | 6146 CHURCHILL DOWNS DR WEST LINN, OR 97068 | PROVIDENCE HEALTH PLAN | $40K | — | $40K | 0.45% |
| BILL LACOUR | 6146 CHURCHILL DOWNS DR WEST LINN, OR 97068 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $55K | $3K | $58K | 1.10% |
| WILLIAM D LACOUR | 3889 N. SIDNEY STREET BUCKEYE, AZ 85396 | RELIANCE STANDARD INSURANCE COMPANY | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NORTHWEST ADMINISTRATORS, INC. EIN 91-0680697 TPA | Contract Administrator Service code 13 | 700 NE MULTNOMAH PORTLAND, OR 97232 | $676K |
| CIGNA EIN 93-6021772 MEDICAL MANAGEMENT | Participant communication; Float revenue; Claims processing; Non-monetary compensation; Named fiduciary; Other services; Contract Administrator; Direct payment from the plan Service code 12 | 8505 EAST ORCHARDROAD,5E8 GREENWOOD VILLAGE, CO 80111 | $413K |
| MILLER NASH GRAHAM & DUNN LLP EIN 93-0410518 LEGAL COUNSEL | Direct payment from the plan; Legal Service code 29 | 111 SW 5TH AVE. PORTLAND, OR 97201 | $170K |
| MODA HEALTH EIN 93-0438772 DENTAL ADMIN FEE | Claims processing Service code 12 | 601 SW SECOND AVE PORTLAND, OR 97204 | $138K |
| KROGER PRESCRIPTION PLAN EIN 20-5927634 RX ADMIN FEE | Claims processing Service code 12 | PO BOX 14002 ROANOKE, VA 24038 | $84K |
| 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 | $41K |
| WITHUM SMITH + BROWN, PC EIN 22-2027092 CONTRIBUTION COMPLIANCE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 9955 SE WASHINGTON ST201 PORTLAND, OR 97216 | $33K |
| TRUCKER HUSS, APC EIN 94-3216063 LEGAL COUNSEL | Direct payment from the plan; Legal Service code 29 | 135 MAIN STREET SAN FRANCISCO, CA 94105 | $32K |
| CAPITOL CITY PRESS EIN 72-0146160 COPYING AND PRINTING | Copying and duplicating Service code 36 | 2975 37TH AVE SW TUMWATER, WA 98512 | $32K |
| VERUS ADVISORY, INC. EIN 91-1320111 INVESTMENT ADVISOR | Direct payment from the plan; Investment advisory (plan); Consulting (general) Service code 16 | PO BOX 303 TUALATIN, OR 97062 | $30K |
| VISION SERVICE PLAN EIN 06-1227840 VISION ADMIN FEE | Claims processing Service code 12 | 7400 GAYLORD PARKWAY FRISCO, TX 75034 | $28K |
| WELLS FARGO BANK EIN 94-1347393 CUSTODIAN | Custodial (other than securities); Trustee (bank, trust company, or similar financial institution) Service code 18 | 420 MONTGOMERY STREET SAN FRANCISCO, CA 94104 | $21K |
| BJORKLUND & MONTPLAISIR EIN 93-1015766 AUDITOR | Accounting (including auditing) Service code 10 | 9020 SW WASHINGTON SQ RD PORTLAND, OR 97223 | $17K |
| METRO PRESORT INC EIN 93-0799990 COPYING AND PRINTING | Copying and duplicating Service code 36 | 3506 NW 35TH AVENUE PORTLAND, OR 97210 | $9K |
| MILLIMAN USA EIN 91-0675641 ACTUARIAL SERVICES | Actuarial; Direct payment from the plan Service code 11 | 111 SW 5TH AVE. PORTLAND, OR 97204 | $8K |
| MEDICAL REVIEW INSTITUTE OF AMERICA CASE MANAGEMENT | Direct payment from the plan; Insurance services; Other services Service code 23 | PO BOX 35145 SEATTLE, WA 98124 | $8K |
| PAUL C. HAYS ATTORNEY EIN 47-3252661 LEGAL COUNSEL | Direct payment from the plan; Legal Service code 29 | 10300 SW GREENBURG ROAD PORTLAND, OR 97223 | $7K |
| WILLIAM LACOUR LLC EIN 43-3675103 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 | 1,587 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 567 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,154 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PROVIDENCE HEALTH PLAN | 1,442 | $14.2M |
| Life insurance | RELIANCE STANDARD INSURANCE COMPANY | 1,413 | $14K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSUANCE COMPANY | 870 | $1.1M |
| Other | RELIANCE STANDARD INSURANCE COMPANY | 1,413 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,442 | — |
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.