Form 5500 · Employee benefit plan · BUTTE, MT
BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC
The filing calls this plan BUTTE-SILVERBOW PRIMARY HEALTHCARE CLINIC INC WRAP PLAN.
Public Form 5500 records show how BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC of BUTTE, MT, a health care and social assistance employer, structures its employee benefits. Its broker of record is ALLIANT INSURANCE SERVICES, INC.. Coverage is written through BLUECROSS BLUESHIELD OF MONTANA and 2 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 81-0432169 · plan 505 · plan year 2025, filed Oct 6, 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, other welfare.
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 3 insured contracts covering health, dental, vision and life; the largest, with BLUECROSS BLUESHIELD OF MONTANA, covers 188 people.
Reported premium across the insured contracts is $1,193,794, with $55,552 in disclosed broker commissions — about 4.7% of premium.
The most recent policy period ended in June, and the plan year ends June 30. Group contracts typically renew on that annual cycle.
ALLIANT INSURANCE SERVICES, INC. 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, including BLUECROSS BLUESHIELD OF MONTANA, DEARBORN LIFE INSURANCE COMPANY and VISION SERVICE PLAN. BLUECROSS BLUESHIELD OF MONTANA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUECROSS BLUESHIELD OF MONTANA | Health, Dental | 188 | Jul 1, 2025 | $1,143,481 | $49,422 |
| DEARBORN LIFE INSURANCE COMPANY | Life | 169 | Jul 1, 2025 | $34,560 | $5,176 |
| VISION SERVICE PLAN | Vision | 111 | Jul 1, 2025 | $15,753 | $954 |
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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