Form 5500 · Employee benefit plan · MASON CITY, IA
MASON CITY CLINIC
The filing calls this plan MASON CITY CLINIC VISION.
Public Form 5500 records show how MASON CITY CLINIC of MASON CITY, IA, a health care and social assistance employer, structures its employee benefits. Its broker of record is DODGE PARTNERS INSURANCE. Coverage is written through UNUM LIFE INSURANCE COMPANY OF AMERICA. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 42-1009288 · plan 508 · plan year 2025, filed Jul 17, 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
Vision: UNUM LIFE INSURANCE COMPANY OF AMERICA covers 10 of 108 participants (9.3%) on Schedule A.
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, vision, through UNUM LIFE INSURANCE COMPANY OF AMERICA.
Reported premium across the insured contracts is $15,707, with $1,885 in disclosed broker commissions — about 12% 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 |
|---|---|---|---|---|---|
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Vision | 10 | Jan 1, 2027 | $15,707 | $1,885 |
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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