Form 5500 · Employee benefit plan · SIOUX FALLS, SD
LUVERNE SUPERMARKET, INC.
LUVERNE SUPERMARKET, INC. of SIOUX FALLS, SD insures health, dental, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is LORI LEWISON, WORKPLACE MARKET INS. Coverage is written through HEALTHPARTNERS INSURANCE COMPANY and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 93-0875450 · plan 501 · plan year 2025, filed Jun 24, 2026
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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
Disability: the largest of the 2 insured disability contracts, with RELIANCE STANDARD LIFE INSURANCE COMPANY, covers 16 of 185 participants (8.6%) on Schedule A.
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 7 insured contracts covering health, dental, life and disability; the largest, with HEALTHPARTNERS INSURANCE COMPANY, covers 158 people.
Reported premium across the insured contracts is $1,583,367, with $50,409 in disclosed broker commissions — about 3.2% 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.
LORI LEWISON, WORKPLACE MARKET INS is the broker of record on 1 of the 7 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including HEALTHPARTNERS INSURANCE COMPANY, DELTA DENTAL OF SOUTH DAKOTA and RELIANCE STANDARD LIFE INSURANCE COMPANY. HEALTHPARTNERS INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| HEALTHPARTNERS INSURANCE COMPANY | Health | 158 | Jan 1, 2026 | $1,455,461 | $42,460 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Disability, Annuity / GIC | 16 | Jan 1, 2026 | $14,412 | $2,171 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Life, Annuity / GIC | 23 | Jan 1, 2026 | $14,194 | $2,111 |
| DELTA DENTAL OF SOUTH DAKOTA | Dental, Annuity / GIC | 204 | Jan 1, 2026 | $81,486 | $1,570 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Life, Annuity / GIC | 170 | Jan 1, 2026 | $6,996 | $758 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Life, Annuity / GIC | 151 | Jan 1, 2026 | $6,996 | $758 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Disability, Annuity / GIC | 8 | Jan 1, 2026 | $3,822 | $581 |
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.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule I
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
How this plan compares
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