Form 5500 · Employee benefit plan · BELOIT, WI
BELOIT HEALTH SYSTEM, INC.
The filing calls this plan BELOIT MEMORIAL HOSPITAL, INC. EMPLOYEE MEDICAL CARE PLAN.
BELOIT HEALTH SYSTEM, INC. of BELOIT, WI is a 806-participant health care and social assistance employer whose group benefits are disclosed in its annual Form 5500 filing. Coverage is written through QBE INSURANCE. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 39-1028081 · plan 501 · plan year 2024, filed Oct 15, 2025
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How this plan is funded
Self-funded as reported
The filing reports a stop-loss contract and no medical premium, which is what a plan that pays its own claims reports.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
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
The filing discloses a single insured line, stop-loss, through QBE INSURANCE, covering 796 people.
The filing declares 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.
The only insured piece of the health benefit is stop-loss coverage, and the filing reports the plan paying its own claims. The premium and commission here are for the stop-loss contract, not for medical premium.
Reported premium is $1,209,322; the filing discloses no broker commission on these contracts.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| QBE INSURANCE | Stop-loss | 796 | Jan 1, 2025 | $1,209,322 | $0 |
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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