Form 5500 · Employee benefit plan · CASPER, WY
CASPER MEDICAL IMAGING
The filing calls this plan CASPER MEDICAL IMAGING GROUP LIFE PLAN.
Public Form 5500 records show how CASPER MEDICAL IMAGING of CASPER, WY, a health care and social assistance employer, structures its employee benefits. Its broker of record is HUB INTERNATIONAL MTN. STATES LTD. Coverage is written through LIFE INSURANCE COMPANY OF NORTH AMERICA. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 83-0212463 · plan 501 · plan year 2025, filed Aug 26, 2026
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
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
The filing discloses a single insured line, life, through LIFE INSURANCE COMPANY OF NORTH AMERICA, covering 121 people.
Reported premium across the insured contracts is $15,896, with $1,703 in disclosed broker commissions — about 11% 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.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| LIFE INSURANCE COMPANY OF NORTH AMERICA | Life | 121 | Jan 1, 2026 | $15,896 | $1,703 |
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.
Other plans filed by this employer
How this plan compares
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