Form 5500 · Employee benefit plan · RICE LAKE, WI
HENRY RAC HOLDING CORP
The filing calls this plan HENRY RAC HOLDING CORP WELFARE BENEFIT WRAP PLAN.
HENRY RAC HOLDING CORP of RICE LAKE, WI spreads its employee benefits across 3 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is JESS JEROME HUMPAL. Coverage is written through UNITEDHEALTHCARE INSURANCE COMPANY and 2 other carriers. The plan's most recent policy period ended in March.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 11-3337304 · plan 505 · plan year 2025, filed Jul 15, 2026
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58 other employer plans in Wisconsin have policy years ending in March. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
How this plan is funded
Both, as reported
The medical insurance contracts on the filing cover fewer than half the people in the plan, so the rest is paid another way.
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: death benefits, 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 4 insured contracts covering health, dental, vision, life and disability; the largest, with UNITEDHEALTHCARE INSURANCE COMPANY, covers 166 people.
Reported premium across the insured contracts is $1,472,219, with $87,469 in disclosed broker commissions — about 5.9% of premium.
The health contract's policy period ended in March, while at least one ancillary line's policy period ended in December. The plan is on a split renewal cycle.
JESS JEROME HUMPAL is the broker of record on 1 of the 4 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including UNITEDHEALTHCARE INSURANCE COMPANY, PRINCIPAL LIFE INSURANCE COMPANY and DELTA DENTAL OF WISCONSIN. UNITEDHEALTHCARE INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| PRINCIPAL LIFE INSURANCE COMPANY | Vision, Life, Disability | 787 | Jan 1, 2026 | $506,234 | $44,391 |
| UNITEDHEALTHCARE INSURANCE COMPANY | Health | 166 | Apr 1, 2025 | $759,929 | $34,904 |
| DELTA DENTAL OF WISCONSIN | Dental | 426 | Jan 1, 2026 | $168,085 | $5,049 |
| UNITEDHEALTHCARE INSURANCE COMPANY | Health, Dental, Vision | 43 | Apr 1, 2025 | $37,971 | $3,125 |
Premium and claims on this contract
DELTA DENTAL OF WISCONSIN, contract 04616 00000. For the contract year on this filing, the carrier reported $167,431 in premium earned and $125,465 in claims incurred. Dividing one by the other gives 75%.
- DELTA DENTAL OF WISCONSIN, contract 04616 00000 reported $28,479 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.
Reported to OSHA
Reported to OSHA for 2025: 688 employees, 21 recordable cases, 186 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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Renewal calendar
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