Form 5500 · Employee benefit plan · HARTLAND, WI
SJOBERG TOOL & MANUFACTURING CORPORATION
The filing calls this plan SJOBERG TOOL & MANUFACTURING CORPORATION GROUP LIFE & DISABILITY PLAN.
SJOBERG TOOL & MANUFACTURING CORPORATION of HARTLAND, WI files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is BROWN AND BROWN INSURANCE SVCS, INC. Coverage is written through UNITED OF OMAHA LIFE INSURANCE COMPANY and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 39-1224767 · plan 502 · plan year 2026, filed Aug 6, 2026
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
One contract on this filing does not say which benefits it covers, so a line above may be insured by it.
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.
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 2 insured contracts covering life and disability; the largest, with UNITED OF OMAHA LIFE INSURANCE COMPANY, covers 106 people.
The filing declares life, disability, health and dental. Health and dental appear with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on the contract here that does not say what it covers.
Reported premium across the insured contracts is $55,831, with $5,071 in disclosed broker commissions — about 9.1% of premium.
The most recent policy period ended in December, and the plan year ends April 30. Group contracts typically renew on that annual cycle.
BROWN AND BROWN INSURANCE SVCS, INC is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life, Disability | 106 | Jan 1, 2026 | $44,186 | $5,071 |
| UNITEDHEALTHCARE INSURANCE COMPANY | — | 106 | May 1, 2026 | $11,645 | $0 |
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: 116 employees, 7 recordable cases, 1 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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