Form 5500 · Employee benefit plan · TRINIDAD, CO
TRINIDAD AREA HEALTH ASSOCIATION
The filing calls this plan MT. SAN RAFAEL HOSPITAL EMPLOYEE BENEFIT PLAN.
TRINIDAD AREA HEALTH ASSOCIATION of TRINIDAD, CO insures vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is ACRISURE LLC. Coverage is written through EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA and 1 other carrier. The plan's most recent policy period ended in April.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 84-0586742 · plan 501 · plan year 2025, filed Oct 29, 2025
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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: other welfare.
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 2 insured contracts covering vision, life and disability; the largest, with EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA, covers 181 people.
The filing declares vision, life, disability, health and dental. Health and dental appear 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 $121,390, with $18,971 in disclosed broker commissions — about 16% of premium.
The most recent policy period ended in April, and the plan year ends April 30. Group contracts typically renew on that annual cycle.
ACRISURE LLC is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 181 | May 1, 2025 | $99,699 | $16,993 |
| EYEMED VISION CARE | Vision | 293 | May 1, 2025 | $21,691 | $1,978 |
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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