Form 5500 · Employee benefit plan · CUMBERLAND, WI
CUMBERLAND HEALTHCARE
The filing calls this plan CUMBERLAND MEMORIAL HOSPITAL, INC. HEALTH AND DENTAL PLAN.
Public Form 5500 records show how CUMBERLAND HEALTHCARE of CUMBERLAND, WI, a health care and social assistance employer, structures its employee benefits. Its broker of record is M3 INSURANCE SOLUTIONS INC.. Coverage is written through SECURITY HEALTH PLAN OF WISCONSIN, INC.. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 39-0831153 · plan 502 · plan year 2024, filed Apr 14, 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
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, health, through SECURITY HEALTH PLAN OF WISCONSIN, INC., covering 274 people.
Reported premium across the insured contracts is $2,686,991, with $39,144 in disclosed broker commissions — about 1.5% of premium.
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 |
|---|---|---|---|---|---|
| SECURITY HEALTH PLAN OF WISCONSIN, INC. | Health | 274 | Jan 1, 2025 | $2,686,991 | $39,144 |
Premium and claims on this contract
SECURITY HEALTH PLAN OF WISCONSIN, INC., contract C0004657757. For the contract year on this filing, the carrier reported $2,686,991 in premium earned and $1,256,653 in claims incurred. Dividing one by the other gives 47%.
- SECURITY HEALTH PLAN OF WISCONSIN, INC., contract C0004657757 reported $212,915 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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