Form 5500 · Employee benefit plan · JACKSONVILLE, FL
CHAMPION BRANDS, INC.
The filing calls this plan CHAMPION BRANDS, INC. WELFARE BENEFIT PLAN.
CHAMPION BRANDS, INC. of JACKSONVILLE, FL insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is MFB FINANCIAL INC DBA THE BAILEY GR. Coverage is written through HEALTH OPTIONS and 5 other carriers. The plan's most recent policy period ended in August.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 59-1474127 · plan 501 · plan year 2025, filed Dec 18, 2025
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits.
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.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
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 6 insured contracts covering health, dental, vision, life and disability; the largest, with HEALTH OPTIONS, covers 135 people.
Reported premium across the insured contracts is $2,808,871, with $105,023 in disclosed broker commissions — about 3.7% of premium.
The most recent policy period ended in August, and the plan year ends August 31. Group contracts typically renew on that annual cycle.
MFB FINANCIAL INC DBA THE BAILEY GR is the broker of record on 2 of the 6 contracts; the rest name a different broker or none.
6 carriers appear on the filing, including HEALTH OPTIONS, BLUE CROSS BLUE SHIELD OF FLORIDA, FLORIDA COMBINED LIFE and UNITED OF OMAHA LIFE INSURANCE COMPANY. HEALTH OPTIONS writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| HEALTH OPTIONS | Health | 135 | Sep 1, 2025 | $1,450,599 | $43,518 |
| BLUE CROSS BLUE SHIELD OF FLORIDA | Health | 96 | Sep 1, 2025 | $1,108,017 | $33,240 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life, Disability | 217 | Sep 1, 2025 | $70,054 | $14,011 |
| FLORIDA COMBINED LIFE | Dental | 245 | Sep 1, 2025 | $138,352 | $12,470 |
| AFLAC | — | 8 | Sep 1, 2025 | $16,751 | $1,784 |
| VISION SERVICE PLAN | Vision | 185 | Sep 1, 2025 | $25,098 | $0 |
Premium and claims on these contracts
HEALTH OPTIONS, contract 15138. For the contract year on this filing, the carrier reported $1,450,599 in premium earned and $1,188,911 in claims incurred. Dividing one by the other gives 82%.
BLUE CROSS BLUE SHIELD OF FLORIDA, contract 15138. For the contract year on this filing, the carrier reported $1,108,017 in premium earned and $790,681 in claims incurred. Dividing one by the other gives 71%.
- HEALTH OPTIONS, contract 15138 reported $261,688 in retention.
- BLUE CROSS BLUE SHIELD OF FLORIDA, contract 15138 reported $317,335 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
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.
Reported to OSHA
Reported to OSHA for 2025: 369 employees, 26 recordable cases, 148 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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