Form 5500 · Employee benefit plan · CHIPLEY, FL
NORTHWEST FLORIDA COMMUNITY HOSPITAL
The filing calls this plan NORTHWEST FLORIDA COMMUNITY HOSPITAL HEALTH BENEFI.
Public Form 5500 records show how NORTHWEST FLORIDA COMMUNITY HOSPITAL of CHIPLEY, FL, a health care and social assistance employer, structures its employee benefits. Its broker of record is ROGERS BENEFIT GROUP INC. Coverage is written through BLUE CROSS BLUE SHIELD OF FLORIDA. The plan's most recent policy period ended in September.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 20-0244662 · plan 501 · plan year 2025, filed Jun 25, 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
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, health, through BLUE CROSS BLUE SHIELD OF FLORIDA, covering 167 people.
Reported premium is $2,072,224; the filing discloses no broker commission on these contracts.
The most recent policy period ended in September, and the plan year ends September 30. Group contracts typically renew on that annual cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA | Health | 167 | Oct 1, 2025 | $2,072,224 | $0 |
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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