Form 5500 · Employee benefit plan · EVANSVILLE, WY
MOSER ENGINE SERVICE, INC.
The filing calls this plan MOSER ENGINE SERVICE, INC. (MOSER ENERGY SYSTEMS) HEALTH AND WELFARE PLAN.
MOSER ENGINE SERVICE, INC. of EVANSVILLE, WY insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is GALLAGHER BENEFIT SERVICES, INC.. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 1 other carrier. The plan's most recent policy period ended in February.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 83-0221447 · plan 501 · plan year 2025, filed Oct 2, 2025
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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
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 2 insured contracts covering health, dental, vision, life and disability; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 121 people.
Reported premium across the insured contracts is $30,767, with $5,252 in disclosed broker commissions — about 17% of premium.
The most recent policy period ended in February, and the plan year ends February 28. Group contracts typically renew on that annual cycle.
GALLAGHER BENEFIT SERVICES, INC. is the broker of record on all 2 contracts.
Two carriers split the book: CIGNA HEALTH AND LIFE INSURANCE COMPANY and METROPOLITAN LIFE INSURANCE COMPANY.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health, Dental | 121 | Mar 1, 2025 | $19,085 | $2,837 |
| METROPOLITAN LIFE INSURANCE COMPANY | Vision, Life, Disability | 350 | Mar 1, 2025 | $11,682 | $2,415 |
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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