Form 5500 · Employee benefit plan · ST CLOUD, MN
KBP NORTHSTAR, LLC
The filing calls this plan SIMONSON PROPERTIES.
KBP NORTHSTAR, LLC of ST CLOUD, MN insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is BROWN & BROWN MINNEAPOLIS. Coverage is written through MEDICA INSURANCE COMPANY and 4 other carriers. The plan's most recent policy period ended in July.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 93-3815733 · plan 501 · plan year 2024, filed Mar 7, 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, 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 MEDICA INSURANCE COMPANY, covers 280 people.
Reported premium across the insured contracts is $1,104,517, with $63,656 in disclosed broker commissions — about 5.8% of premium.
The most recent policy period ended in July, and the plan year ends July 31. Group contracts typically renew on that annual cycle.
BROWN & BROWN MINNEAPOLIS is the broker of record on 1 of the 5 contracts; the rest name a different broker or none.
5 carriers appear on the filing, including MEDICA INSURANCE COMPANY, DELTA DENTAL OF MINNESOTA, UNITED OF OMAHA LIFE INSURANCE COMPANY and COLONIAL LIFE & ACCIDENT INSURANCE COMPANY. MEDICA INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| MEDICA INSURANCE COMPANY | Health | 280 | Aug 1, 2024 | $938,632 | $42,041 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | Health, Life, Disability | 97 | Aug 1, 2024 | $44,823 | $7,526 |
| DELTA DENTAL OF MINNESOTA | Dental | 230 | Aug 1, 2024 | $64,123 | $7,321 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life, Disability | 409 | Aug 1, 2024 | $50,435 | $5,793 |
| EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | Vision | 159 | Aug 1, 2024 | $6,504 | $975 |
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: 259 employees, 21 recordable cases, 5 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
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