Form 5500 · Employee benefit plan · ST. LOUIS PARK, MN
ASSOCIATED CLINIC OF PSYCHOLOGY, INC.
The filing calls this plan ASSOCIATED CLINIC OF PSYCHOLOGY, INC. COMPREHENSIVE HEALTH & WELFARE BENEFITS PLAN.
ASSOCIATED CLINIC OF PSYCHOLOGY, INC. of ST. LOUIS PARK, MN is a 212-participant health care and social assistance employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is USI INSURANCE SERVICES LLC. Coverage is written through MEDICA INSURANCE COMPANY and 3 other carriers. The plan's most recent policy period ended in August.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 41-1425197 · plan 514 · plan year 2025, filed Feb 18, 2026
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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.
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 4 insured contracts covering health, dental, vision and life; the largest, with MEDICA INSURANCE COMPANY, covers 174 people.
Reported premium across the insured contracts is $2,487,901, with $132,323 in disclosed broker commissions — about 5.3% of premium.
The most recent policy period ended in August, and the plan year ends August 31. Group contracts typically renew on that annual cycle.
USI INSURANCE SERVICES LLC is the broker of record on all 4 contracts.
4 carriers appear on the filing, including MEDICA INSURANCE COMPANY, DELTA DENTAL OF MINNESOTA, UNITED OF OMAHA LIFE INSURANCE COMPANY and EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO.. MEDICA INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| MEDICA INSURANCE COMPANY | Health | 174 | Sep 1, 2025 | $2,364,665 | $118,233 |
| DELTA DENTAL OF MINNESOTA | Dental | 194 | Sep 1, 2025 | $86,107 | $8,518 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 221 | Sep 1, 2025 | $27,647 | $4,147 |
| EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | Vision | 121 | Sep 1, 2025 | $9,482 | $1,425 |
Premium and claims on this contract
DELTA DENTAL OF MINNESOTA, contract 102392. For the contract year on this filing, the carrier reported $86,103 in premium earned and $49,857 in claims incurred. Dividing one by the other gives 58%.
- DELTA DENTAL OF MINNESOTA, contract 102392 reported $26,632 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.
Reported to OSHA
Reported to OSHA for 2025: 272 employees, 0 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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