Form 5500 · Employee benefit plan · WANSHIP, UT
THE LODGE AT BLUE SKY
The filing calls this plan THE LODGE AT BLUE SKY WELFARE BENEFIT PLAN.
THE LODGE AT BLUE SKY of WANSHIP, UT files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is HUB INTERNATIONAL INS. SVCES., INC.. Coverage is written through AMERITAS LIFE INSURANCE CORP. and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 83-0984617 · plan 501 · plan year 2025, filed Jun 17, 2026
Get an email when this employer files a new Form 5500, and again about four months before its plan renews.
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
One contract on this filing does not say which benefits it covers, so a line above may be insured by it.
Also declared: prepaid legal, 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 3 insured contracts covering dental, vision, life and disability; the largest, with AMERITAS LIFE INSURANCE CORP., covers 180 people.
The filing declares dental, vision, life, disability and health. Health appears with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on the contract here that does not say what it covers.
Reported premium across the insured contracts is $129,047, with $22,046 in disclosed broker commissions — about 17% 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 INTERNATIONAL INS. SVCES., INC. is the broker of record on 2 of the 3 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| AMERITAS LIFE INSURANCE CORP. | Dental, Vision | 180 | Jan 1, 2026 | $72,479 | $10,872 |
| HARTFORD LIFE AND ACCIDENT | Life, Disability | 153 | Jan 1, 2026 | $53,385 | $10,613 |
| PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | — | 12 | Jan 1, 2026 | $3,183 | $561 |
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.
Reported to OSHA
Reported to OSHA for 2025: 206 employees, 8 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
How this plan compares
Subscribers see how this compares with similar plans in Utah. A subscription also adds this plan's filing history and the renewal calendar for its state. See plans and prices
Without an account you can open 10 employer, broker and carrier pages a day, including through an AI assistant, and 50 a day with a free account. Paid plans are what keep these records free to read.
More employer plans in Utah — largest plans, brokers, carriers and renewal months.