Form 5500 · Employee benefit plan · MENOMONEE FALLS, WI
KOHL'S, INC.
The filing calls this plan KOHL'S GROUP HEALTH PLAN.
KOHL'S, INC. of MENOMONEE FALLS, WI files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is MERCER HEALTH & BENEFITS LLC. Coverage is written through KAISER FOUNDATION HEALTH PLAN, INC. (CALIFORNIA) and 7 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 13-3357362 · plan 501 · plan year 2024, filed Oct 15, 2025
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1,633 other employer plans in Wisconsin have policy years ending in December. 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
Health: the largest of the 2 insured health contracts, with KAISER FOUNDATION HEALTH PLAN, INC. (CALIFORNIA), covers 600 of 106,207 participants (0.6%) on Schedule A.
Dental: DELTA DENTAL OF WISCONSIN covers 3,297 of 106,207 participants (3.1%) on Schedule A.
Disability: LIFE INSURANCE COMPANY OF NORTH AMERICA covers 3,206 of 106,207 participants (3%) on Schedule A.
Also declared: prepaid legal, 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 13 insured contracts covering health, dental, vision, life and disability.
Reported premium across the insured contracts is $19,667,630, with $1,078,277 in disclosed broker commissions — about 5.5% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in February. The plan is on a split renewal cycle.
MERCER HEALTH & BENEFITS LLC is the broker of record on 7 of the 13 contracts; the rest name a different broker or none.
8 carriers appear on the filing, including KAISER FOUNDATION HEALTH PLAN, INC. (CALIFORNIA), UNITEDHEALTHCARE INSURANCE COMPANY, SECURIAN LIFE INSURANCE COMPANY and DELTA DENTAL OF WISCONSIN. KAISER FOUNDATION HEALTH PLAN, INC. (CALIFORNIA) writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| SECURIAN LIFE INSURANCE COMPANY | Life | 13,620 | Jan 1, 2025 | $2,515,921 | $251,592 |
| UNITEDHEALTHCARE INSURANCE COMPANY | — | 5,499 | Jan 1, 2025 | $1,989,328 | $197,678 |
| UNITEDHEALTHCARE INSURANCE COMPANY | Vision | 31,710 | Jan 1, 2025 | $2,790,856 | $149,870 |
| SECURIAN LIFE INSURANCE COMPANY | Life | 29,702 | Jan 1, 2025 | $1,278,071 | $127,807 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA | Disability | 3,206 | Jan 1, 2025 | $1,189,342 | $95,147 |
| KAISER FOUNDATION HEALTH PLAN, INC. (CALIFORNIA) | Health | 600 | Jan 1, 2025 | $4,403,546 | $80,598 |
| KAISER FOUNDATION HEALTH PLAN, INC. (CALIFORNIA) | Health | 424 | Jan 1, 2025 | $3,057,839 | $56,787 |
| DELTA DENTAL OF WISCONSIN | Dental | 3,297 | Jan 1, 2025 | $1,329,989 | $53,200 |
| SECURIAN LIFE INSURANCE COMPANY | — | 4,392 | Jan 1, 2025 | $304,854 | $30,485 |
| METROPOLITAN GENERAL INSURANCE COMPANY | — | 1,495 | Jan 1, 2025 | $276,066 | $24,102 |
| FEDERAL INSURANCE COMPANY | — | 30,029 | Mar 1, 2024 | $53,629 | $10,726 |
| FEDERAL INSURANCE COMPANY | — | 30,029 | Mar 1, 2023 | $1,424 | $285 |
| COMPSYCH CORPORATION | — | 103,577 | Jan 1, 2025 | $476,765 | $0 |
Premium and claims on this contract
DELTA DENTAL OF WISCONSIN, contract 50406. For the contract year on this filing, the carrier reported $1,316,934 in premium earned and $1,110,505 in claims incurred. Dividing one by the other gives 84%.
- DELTA DENTAL OF WISCONSIN, contract 50406 reported $210,971 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. The service providers are named on Schedule C of this filing. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 77,513 employees, 1,299 recordable cases, 11,313 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
2 establishments filed under this EIN are left out of these figures: the hours and employees they reported could not both be right.
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
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