Form 5500 · Employee benefit plan · CROOKSTON, MN
TRI-VALLEY OPPORTUNITY COUNCIL, INC.
The filing calls this plan TRI-VALLEY OPPORTUNITY COUNCIL, INC. WELFARE BENEFIT PLAN.
Public Form 5500 records show how TRI-VALLEY OPPORTUNITY COUNCIL, INC. of CROOKSTON, MN, a health care and social assistance employer, structures its employee benefits. Its broker of record is MARSH MCLENNAN AGENCY LLC. Coverage is written through STARMOUNT LIFE INSURANCE COMPANY and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 41-0888488 · plan 501 · plan year 2025, filed Apr 13, 2026
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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.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
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 5 insured contracts covering dental, vision, life and disability; the largest, with STARMOUNT LIFE INSURANCE COMPANY, covers 104 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, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $236,867, with $25,840 in disclosed broker commissions — about 11% 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.
MARSH MCLENNAN AGENCY LLC is the broker of record on 1 of the 5 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| STARMOUNT LIFE INSURANCE COMPANY | Dental | 104 | Jan 1, 2026 | $92,725 | $10,034 |
| STANDARD INSURANCE COMPANY | Life | 235 | Jan 1, 2026 | $38,160 | $6,375 |
| STANDARD INSURANCE COMPANY | Disability | 234 | Jan 1, 2026 | $49,928 | $3,776 |
| STANDARD INSURANCE COMPANY | Disability | 44 | Jan 1, 2026 | $34,608 | $3,295 |
| STANDARD INSURANCE COMPANY | Vision | 101 | Jan 1, 2026 | $21,446 | $2,360 |
Premium and claims on these contracts
STANDARD INSURANCE COMPANY, contract 758645. For the contract year on this filing, the carrier reported $38,160 in premium earned and $-25 in claims incurred. Dividing one by the other gives -0%.
STANDARD INSURANCE COMPANY, contract 758645. For the contract year on this filing, the carrier reported $49,928 in premium earned and $24,659 in claims incurred. Dividing one by the other gives 49%.
STANDARD INSURANCE COMPANY, contract 758645. For the contract year on this filing, the carrier reported $34,608 in premium earned and $4,780 in claims incurred. Dividing one by the other gives 14%.
STANDARD INSURANCE COMPANY, contract 758645. For the contract year on this filing, the carrier reported $21,446 in premium earned and $6,969 in claims incurred. Dividing one by the other gives 32%.
- STANDARD INSURANCE COMPANY, contract 758645 reported $38,182 in retention.
- STANDARD INSURANCE COMPANY, contract 758645 reported $25,268 in retention.
- STANDARD INSURANCE COMPANY, contract 758645 reported $29,826 in retention.
- STANDARD INSURANCE COMPANY, contract 758645 reported $12,594 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
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.
Reported to OSHA
Reported to OSHA for 2025: 318 employees, 16 recordable cases, 16 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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