# WESTERN STATES LODGING EMPLOYEE BENEFITS PLAN

Health and welfare plan sponsored by **WESTERN STATES LODGING AND MANAGEMENT, L.C.**. Form 5500 filing for plan year 2025.

| Field | Value |
|---|---|
| Sponsor | WESTERN STATES LODGING AND MANAGEMENT, L.C. |
| EIN | 870520716 |
| Plan number | 501 |
| Plan year | 2025 |
| Location | SOUTH JORDAN, UT |
| Industry | Professional, Scientific, and Technical Services |
| Funding | fully insured |
| Total premiums | $10.3M |
| Participants | 652 |
| Persons covered | 1,484 |

## Insurance carriers (Schedule A)

| Carrier | Coverage |
|---|---|
| SELECTHEALTH | Health, Rx, PPO |
| COMBINED INSURANCE COMPANY OF AMERICA | STD, Other |
| HAWAII MEDICAL SERVICE ASSOCIATION | Health, Rx, Dental, Vision |
| DELTA DENTAL OF CALIFORNIA | Dental |
| UNITED HERITAGE LIFE INSURANCE COMPANY | Life, LTD, Other |
| UNITEDHEALTHCARE INSURANCE COMPANY | Vision |

## Brokers

| Broker | Placed with |
|---|---|
| GALLAGHER BENEFIT SERVICES, INC. | SELECTHEALTH |
| GALLAGHER BENEFIT SERVICES, INC. | COMBINED INSURANCE COMPANY OF AMERICA |
| BENEFITS ALL INSURANCE, LLC | COMBINED INSURANCE COMPANY OF AMERICA |
| GALLAGHER BENEFIT SERVICES, INC. | HAWAII MEDICAL SERVICE ASSOCIATION |
| GALLAGHER BENEFIT SERVICES, INC. | DELTA DENTAL INSURANCE COMPANY |
| ERIK SNOW | UNITED HERITAGE LIFE INSURANCE COMPANY |
| GALLAGHER BENEFIT SERVICES, INC. | UNITEDHEALTHCARE INSURANCE COMPANY |

## About this data

- Source: public Form 5500 filings from the U.S. Department of Labor (EBSA), rebuilt on each DOL release.
- Full page (charts, history, peer benchmarks, fees, contacts): https://planoptica.com/welfare/870520716-501
- Cite as: PlanOptica, https://planoptica.com/welfare/870520716-501
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