Form 5500 · Employee benefit plan · TULSA, OK
ELLSWORTH CONSTRUCTION, LLC
The filing calls this plan ELLSWORTH CONSTRUCTION, LLC WELFARE BENEFIT PLAN.
Public Form 5500 records show how ELLSWORTH CONSTRUCTION, LLC of TULSA, OK, a construction employer, structures its employee benefits. Its broker of record is HUB INTERNATIONAL MIDWEST. Coverage is written through BLUECROSS BLUESHIELD OF OKLAHOMA and 3 other carriers. The plan's most recent policy period ended in November.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 20-1717097 · plan 502 · plan year 2025, filed Jun 23, 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: 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.
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 4 insured contracts covering health, dental, vision, life and disability; the largest, with BLUECROSS BLUESHIELD OF OKLAHOMA, covers 165 people.
Reported premium across the insured contracts is $1,170,875, with $55,753 in disclosed broker commissions — about 4.8% of premium.
The most recent policy period ended in November, and the plan year ends November 30. Group contracts typically renew on that annual cycle.
HUB INTERNATIONAL MIDWEST is the broker of record on 2 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including BLUECROSS BLUESHIELD OF OKLAHOMA, UNITED OF OMAHA LIFE INSURANCE COMPANY, DELTA DENTAL and COMMUNITYCARE HMO. BLUECROSS BLUESHIELD OF OKLAHOMA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUECROSS BLUESHIELD OF OKLAHOMA | Health | 165 | Dec 1, 2025 | $989,468 | $49,828 |
| DELTA DENTAL | Dental | 114 | Dec 1, 2025 | $74,068 | $5,925 |
| COMMUNITYCARE HMO | Health | 140 | Dec 1, 2025 | $1,243 | $0 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Vision, Life, Disability | 247 | Dec 1, 2025 | $106,096 | — |
Premium and claims on this contract
DELTA DENTAL, contract 6646. For the contract year on this filing, the carrier reported $74,068 in premium earned and $67,013 in claims incurred. Dividing one by the other gives 90%.
- DELTA DENTAL, contract 6646 reported $10,699 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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