Form 5500 · Employee benefit plan · JANESVILLE, WI
COEXTRUDED PLASTIC TECHNOLOGIES DBA CPT, INC.
The filing calls this plan CPT, INC EMPLOYEE BENEFITS PLAN.
COEXTRUDED PLASTIC TECHNOLOGIES DBA CPT, INC. of JANESVILLE, WI spreads its employee benefits across 4 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is HUB INTERNATIONAL LIMITED. Coverage is written through MERCYCARE INSURANCE COMPANY and 3 other carriers. The plan's most recent policy period ended in October.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 39-1996506 · plan 502 · plan year 2024, filed May 28, 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: 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.
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 5 insured contracts covering health, dental, vision, life and disability; the largest, with MERCYCARE INSURANCE COMPANY, covers 205 people.
Reported premium across the insured contracts is $1,299,174, with $50,646 in disclosed broker commissions — about 3.9% of premium.
The most recent policy period ended in October, and the plan year ends October 31. Group contracts typically renew on that annual cycle.
HUB INTERNATIONAL LIMITED is the broker of record on 2 of the 5 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including MERCYCARE INSURANCE COMPANY, DELTA DENTAL OF WISCONSIN, EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA and WYSSTA INSURANCE COMPANY INC. MERCYCARE INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| MERCYCARE INSURANCE COMPANY | Health | 205 | Nov 1, 2024 | $1,162,280 | $34,719 |
| EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 108 | Nov 1, 2024 | $57,857 | $9,881 |
| DELTA DENTAL OF WISCONSIN | Dental | 108 | Nov 1, 2024 | $66,353 | $5,224 |
| WYSSTA INSURANCE COMPANY INC | Vision | 108 | Nov 1, 2024 | $8,822 | $706 |
| MERCYCARE INSURANCE COMPANY | Health | 2 | Nov 1, 2024 | $3,862 | $116 |
Premium and claims on this contract
DELTA DENTAL OF WISCONSIN, contract 08416 00000. For the contract year on this filing, the carrier reported $66,106 in premium earned and $33,371 in claims incurred. Dividing one by the other gives 50%.
- DELTA DENTAL OF WISCONSIN, contract 08416 00000 reported $14,485 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.
Other plans filed by this employer
How this plan compares
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