Form 5500 · Employee benefit plan · EUGENE, OR
SUMMIT BANK
SUMMIT BANK of EUGENE, OR is a 128-participant finance and insurance employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is USI INSURANCE SERVICES NORTHWEST. 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 41-2114771 · 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 160 people.
Reported premium across the insured contracts is $1,476,345, with $55,917 in disclosed broker commissions — about 3.8% 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.
USI INSURANCE SERVICES NORTHWEST is the broker of record on 2 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing — PROVIDENCE HEALTH PLAN, PRINCIPAL LIFE INSURANCE COMPANY 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 | 160 | December | $1,319,100 | $39,573 |
| PRINCIPAL LIFE INSURANCE COMPANY | Dental, Vision, Life, Disability | 188 | December | $139,064 | $15,435 |
| WILLAMETTE DENTAL INSURANCE, INC. | Dental | 40 | December | $18,181 | $909 |
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