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Form 5500 · Employee benefit plan · PLAINS, MT

PLAINS HOSPITAL CORPORATION DBA CLARK FORK VALLEY HOSPITAL

PLAINS HOSPITAL CORPORATION DBA CLARK FORK VALLEY HOSPITAL of PLAINS, MT spreads its employee benefits across 3 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is PAYNEWEST INSURANCE A MARSH & MCLEN. Coverage is written through PACIFICSOURCE HEALTH PLANS and 2 other carriers. The plan's most recent policy period ended in December.

Benefits broker of record
Plan renews
December

Sourced from U.S. DOL EFAST2 Form 5500 · EIN 81-0475376 · plan 501 · as of Aug 2026

Participants
178
Carriers on file
4
Disclosed commissions
$74,526
Renewal month
December

Plan brief

Schedule A lists 4 insured contracts covering health, dental, vision, life and disability; the largest, with PACIFICSOURCE HEALTH PLANS, covers 144 people.

Reported premium across the insured contracts is $2,115,129, with $74,526 in disclosed broker commissions — about 3.5% 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.

PAYNEWEST INSURANCE A MARSH & MCLEN is the broker of record on 1 of the 4 contracts; the rest name a different broker or none.

3 carriers appear on the filing — PACIFICSOURCE HEALTH PLANS, PRINCIPAL LIFE INSURANCE COMPANY and THE LINCOLN NATIONAL LIFE INSURANCE COMPANY — with PACIFICSOURCE HEALTH PLANS writing the largest contract by premium.

Schedule A insurance contracts

CarrierBenefitsCoveredRenewsPremiumCommission
PACIFICSOURCE HEALTH PLANSHealth144December$1,969,282$59,147
PRINCIPAL LIFE INSURANCE COMPANYDental, Vision, Disability79December$113,820$10,575
THE LINCOLN NATIONAL LIFE INSURANCE COMPANYLife39December$25,053$3,758
THE LINCOLN NATIONAL LIFE INSURANCE COMPANYLife173December$6,974$1,046

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