Form 5500 · Employee benefit plan · SHEBOYGAN, WI
ACUITY, A MUTUAL INSURANCE COMPANY
The filing calls this plan ACUITY EXECUTIVE LTD PLOL PLAN.
ACUITY, A MUTUAL INSURANCE COMPANY of SHEBOYGAN, WI files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is KME INSURANCE BROKERAGE, INC.. Coverage is written through PETERSEN INTERNATIONAL UNDERWRITERS. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 39-0491540 · plan 507 · plan year 2025, filed Dec 17, 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
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
The filing discloses a single insured line, disability, through PETERSEN INTERNATIONAL UNDERWRITERS, covering 11 people.
Reported premium across the insured contracts is $135,000, with $39,314 in disclosed broker commissions — about 29% of premium.
The most recent policy period ended in May, and the plan year ends May 31. Group contracts typically renew on that annual cycle.
At 11 participants this is a small group; Form 5500 is required once a welfare plan reaches 100 participants, or when it is funded through insurance contracts.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| PETERSEN INTERNATIONAL UNDERWRITERS | Disability | 11 | Jun 1, 2025 | $135,000 | $39,314 |
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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