Form 5500 · Employee benefit plan · MEDFORD, OR
VALLEY IMMEDIATE CARE, LLC
The filing calls this plan VALLEY IMMEDIATE CARE, LLC GROUP BENEFITS PLAN.
Public Form 5500 records show how VALLEY IMMEDIATE CARE, LLC of MEDFORD, OR, a health care and social assistance employer, structures its employee benefits. Its broker of record is HUB INTERNATIONAL NORTHWEST, LLC. Coverage is written through REGENCE BLUECROSS BLUESHIELD OF OREGON and 4 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 93-1274337 · plan 501 · plan year 2024, filed Aug 25, 2025
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 6 insured contracts covering health, dental, vision, life and disability; the largest, with REGENCE BLUECROSS BLUESHIELD OF OREGON, covers 111 people.
Reported premium across the insured contracts is $992,138, with $29,640 in disclosed broker commissions — about 3% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in February. The plan is on a split renewal cycle.
HUB INTERNATIONAL NORTHWEST, LLC is the broker of record on 3 of the 6 contracts; the rest name a different broker or none.
5 carriers appear on the filing, including REGENCE BLUECROSS BLUESHIELD OF OREGON, OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON, THE LINCOLN NATIONAL LIFE INSURANCE COMPANY and WILLAMETTE DENTAL INSURANCE, INC.. REGENCE BLUECROSS BLUESHIELD OF OREGON writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| REGENCE BLUECROSS BLUESHIELD OF OREGON | Health | 111 | Jan 1, 2025 | $886,449 | $24,300 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | Life, Disability | 126 | Jan 1, 2025 | $30,094 | $3,182 |
| WILLAMETTE DENTAL INSURANCE, INC. | Dental | 55 | Jan 1, 2025 | $29,296 | $1,465 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | Vision | 69 | Jan 1, 2025 | $6,268 | $627 |
| LIFEMAP ASSURANCE COMPANY | Vision | 63 | Mar 1, 2024 | $1,372 | $66 |
| OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | Dental | 65 | Jan 1, 2025 | $38,659 | $0 |
Premium and claims on this contract
WILLAMETTE DENTAL INSURANCE, INC., contract OR314. For the contract year on this filing, the carrier reported $29,296 in premium earned and $26,756 in claims incurred. Dividing one by the other gives 91%.
- WILLAMETTE DENTAL INSURANCE, INC., contract OR314 reported $5,127 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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