Form 5500 · Employee benefit plan · PORTLAND, OR
PEREGRINE SPORTS, LLC
PEREGRINE SPORTS, LLC of PORTLAND, OR files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is HUB INTERNATIONAL NORTHWEST LLC. Coverage is written through PROVIDENCE HEALTH PLAN and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 36-4652297 · plan 501 · as of Aug 2026
Plan brief
Schedule A lists 3 insured contracts covering health, dental, vision, life and disability; the largest, with PROVIDENCE HEALTH PLAN, covers 248 people.
Reported premium across the insured contracts is $1,797,127, with $60,495 in disclosed broker commissions — about 3.4% 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 LLC is the broker of record on all 3 contracts.
3 carriers appear on the filing — PROVIDENCE HEALTH PLAN, THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA and WILLAMETTE DENTAL INSURANCE, INC. — with PROVIDENCE HEALTH PLAN writing the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| PROVIDENCE HEALTH PLAN | Health, Vision | 248 | December | $1,620,397 | $48,612 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Life, Disability | 174 | December | $124,035 | $9,248 |
| WILLAMETTE DENTAL INSURANCE, INC. | Dental | 106 | December | $52,695 | $2,635 |
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