Form 5500 · Employee benefit plan · LINCOLN CITY, OR
CONFEDERATED TRIBES OF SILETZ INDIANS; CHINOOK WINDS CASINO RESORT
CONFEDERATED TRIBES OF SILETZ INDIANS; CHINOOK WINDS CASINO RESORT of LINCOLN CITY, OR insures dental, vision, life, disability and stop-loss coverage for its employees, per Schedule A of its Form 5500. Its broker of record is HUB INTERNATIONAL NORTHWEST. Coverage is written through QBE INSURANCE and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 93-0714057 · plan 501 · as of Aug 2026
Plan brief
Schedule A lists 5 insured contracts covering dental, vision, life, disability and stop-loss; the largest, with QBE INSURANCE, covers 727 people.
The only insured piece of the health benefit is stop-loss coverage — the plan itself is self-funded, so premium and commission here reflect the stop-loss contract, not medical premium.
Reported premium across the insured contracts is $1,740,379, with $26,344 in disclosed broker commissions — about 1.5% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
HUB INTERNATIONAL NORTHWEST is the broker of record on 2 of the 5 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life | 352 | December | $180,515 | $26,344 |
| VISION SERVICE PLAN | Vision | 707 | December | $14,940 | $0 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 883 | December | $458,864 | $0 |
| QBE INSURANCE | Stop-loss | 727 | December | $674,069 | $0 |
| OREGON DENTAL SERVICES DBA DELTA DENTAL PLAN OF OREGON | Dental | 927 | December | $411,991 | $0 |
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