Form 5500 · Employee benefit plan · EVANSVILLE, IN
SHOE CARNIVAL, INC.
The filing calls this plan SHOE CARNIVAL, INC. HEALTH AND WELFARE PLAN.
Public Form 5500 records show how SHOE CARNIVAL, INC. of EVANSVILLE, IN, a retail employer, structures its employee benefits. Its broker of record is MERCER HEALTH & BENEFITS LLC. Coverage is written through DELTA DENTAL OF INDIANA and 4 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 35-1736614 · plan 501 · plan year 2025, filed Sep 23, 2026
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1,291 other employer plans in Indiana 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
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 12 insured contracts covering health, dental, vision, life and disability; the largest, with DELTA DENTAL OF INDIANA, covers 2,589 people.
Reported premium across the insured contracts is $2,561,297, with $201,063 in disclosed broker commissions — about 7.9% 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.
MERCER HEALTH & BENEFITS LLC is the broker of record on 6 of the 12 contracts; the rest name a different broker or none.
5 carriers appear on the filing, including DELTA DENTAL OF INDIANA, UNIFIED LIFE INSURANCE COMPANY, RELIANCE STANDARD LIFE INSURANCE COMPANY and ANTHEM INSURANCE COMPANIES, INC.. DELTA DENTAL OF INDIANA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Life | 760 | Jan 1, 2026 | $231,706 | $34,756 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Disability | 314 | Jan 1, 2026 | $226,407 | $33,961 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | — | 522 | Jan 1, 2026 | $120,956 | $24,191 |
| DELTA DENTAL OF INDIANA | Health, Dental | 2,589 | Jan 1, 2026 | $721,362 | $21,688 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | — | 547 | Jan 1, 2026 | $88,145 | $17,629 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | — | 402 | Jan 1, 2026 | $87,550 | $17,510 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Disability | 892 | Jan 1, 2026 | $142,758 | $14,276 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Life | 2,419 | Jan 1, 2026 | $105,732 | $9,271 |
| TRIPLE S SALUD, INC. | Health, Dental | 28 | Jan 1, 2026 | $184,640 | $9,140 |
| ANTHEM INSURANCE COMPANIES, INC. | Vision | 2,300 | Jan 1, 2026 | $229,969 | $8,456 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Disability | 130 | Jan 1, 2026 | $41,925 | $8,385 |
| UNIFIED LIFE INSURANCE COMPANY | Health | 36 | Jan 1, 2026 | $380,147 | $1,800 |
Premium and claims on this contract
DELTA DENTAL OF INDIANA, contract 1201. For the contract year on this filing, the carrier reported $721,301 in premium earned and $595,530 in claims incurred. Dividing one by the other gives 83%.
- DELTA DENTAL OF INDIANA, contract 1201 reported $100,261 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: 269 employees, 14 recordable cases, 35 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
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