Form 5500 · Employee benefit plan · ST. PAUL, MN
H. B. FULLER COMPANY
The filing calls this plan H.B. FULLER COMPANY RETIREE MEDICAL PLAN.
H. B. FULLER COMPANY of ST. PAUL, MN is a 660-participant manufacturing employer whose group benefits are disclosed in its annual Form 5500 filing. Coverage is written through BLUE CROSS AND BLUE SHIELD OF MINNESOTA and 1 other carrier. The plan's most recent policy period ended in November.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 41-0268370 · plan 509 · plan year 2025, filed Sep 15, 2026
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How this plan is funded
Self-funded as reported
The filing reports benefits paid from the plan's own money, and no medical insurance contract on Schedule A.
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
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
Schedule A lists 2 insured contracts covering health and life.
The most recent policy period ended in November, and the plan year ends November 30. Group contracts typically renew on that annual cycle.
No broker of record is named on the Schedule A. The contracts may be written directly with the carrier, or the broker fields were left blank on the filing.
Two carriers split the book: BLUE CROSS AND BLUE SHIELD OF MINNESOTA and MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF MINNESOTA | Health | 70 | Dec 1, 2025 | — | $0 |
| MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | Life | 382 | Dec 1, 2025 | — | $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. The service providers are named on Schedule C of this filing. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 658 employees, 14 recordable cases, 539 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
Other plans filed by this employer
How this plan compares
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