Tri-State Memorial Hospital, Inc.
Overview
Tri-State Memorial Hospital, Inc. sponsors a self-funded health plan that covered 689 participants in plan year 2025, about the same as the prior year. The plan year starts in January. Alongside medical, its benefits filing reports life insurance, dental, short-term disability, long-term disability, and more.
- Plan type
- ERISA welfare benefit plan, self-funded (benefits paid from employer assets or a trust)
- Participants
- 689 · prior year 684
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- Tri-State Memorial Hospital, Inc. Welfare Benefit Plan, plan 501 (689 participants)
- Broker compensation
- $72K across insured contracts
Insurance carriers
Insured coverage reported on Schedule A. Self-funded medical claims aren't reported there.
| Carrier | Coverage | Covered | Premium | Broker comp |
|---|---|---|---|---|
| Hartford Life and Accident | Life, Short-term disability, Long-term disability, Voluntary Accident, Voluntary Critical I | 915 | $449K | $72K |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 689 participants × $2,371 national average per member. Usually higher once dependents are counted.
Typical savings opportunity found in independent reviews of plans this size.
Form 5500 filing details
- Filing
- Form 5500 with Schedule A, plan year 2025
- Plan sponsor
- Tri-State Memorial Hospital, Inc.
- Sponsor EIN
- 91-0545036
- Plan number
- 501
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 91-0545036 in the Department of Labor's EFAST2 Form 5500 search.
Retirement plan
- Plan
- Tri-State Memorial Hospital, Inc. Retirement Plan
- Type
- Defined contribution plan
- Participants
- 864
About this data
Source: Tri-State Memorial Hospital, Inc.'s Form 5500 filing for plan year 2025 and its Schedule A insurance reports, published by the U.S. Department of Labor. "Self-funded" means the filing reports benefits paid from employer assets or a trust, with no medical insurance contract or with a stop-loss contract. Pharmacy figures are StreamRX estimates based on national averages. StreamRX is not affiliated with Tri-State Memorial Hospital, Inc..