Form 5500 · Employee benefit plan · HAVRE, MT
NORTHERN MONTANA HOSPITAL
NORTHERN MONTANA HOSPITAL of HAVRE, MT files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is HUB INT'L MOUNTAIN STATES LIMITED. Coverage is written through HEALTH CARE SERVICE CORPORATION and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 81-0231787 · plan 503 · as of Aug 2026
Plan brief
Schedule A lists 3 insured contracts covering health, dental and life; the largest, with HEALTH CARE SERVICE CORPORATION, covers 355 people.
Reported premium across the insured contracts is $3,180,551, with $53,528 in disclosed broker commissions — about 1.7% 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.
HUB INT'L MOUNTAIN STATES LIMITED 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 — HEALTH CARE SERVICE CORPORATION, UNUM LIFE INSURANCE COMPANY OF AMERICA and DELTA DENTAL INSURANCE COMPANY — with HEALTH CARE SERVICE CORPORATION writing the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| HEALTH CARE SERVICE CORPORATION | Health | 355 | December | $2,884,270 | $30,000 |
| DELTA DENTAL INSURANCE COMPANY | Dental | 410 | December | $136,332 | $13,615 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life | 428 | December | $159,949 | $9,913 |
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