Form 5500 · Employee benefit plan · PARK FALLS, WI
ST. CROIX OF PARK FALLS, LTD
The filing calls this plan ST. CROIX OF PARK FALLS, LTD. EMPLOYEE BENEFITS PLAN.
ST. CROIX OF PARK FALLS, LTD of PARK FALLS, WI spreads its employee benefits across 3 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is ANSAY & ASSOCIATES LLC. Coverage is written through DELTA DENTAL OF WISCONSIN and 2 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 39-1287923 · plan 505 · plan year 2025, filed Oct 16, 2025
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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
Also declared: 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 3 insured contracts covering dental, vision, life and disability; the largest, with DELTA DENTAL OF WISCONSIN, covers 88 people.
The filing declares dental, vision, life, disability and health. Health appears with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $123,603, with $11,541 in disclosed broker commissions — about 9.3% of premium.
The most recent policy period ended in June, and the plan year ends June 30. Group contracts typically renew on that annual cycle.
ANSAY & ASSOCIATES LLC is the broker of record on all 3 contracts.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| SUN LIFE ASSURANCE COMPANY OF CANADA | Life, Disability | 136 | Jul 1, 2025 | $39,809 | $5,882 |
| DELTA DENTAL OF WISCONSIN | Dental | 88 | Jul 1, 2025 | $71,119 | $5,025 |
| NATIONAL VISION ADMINISTRATORS, LLC | Vision | 88 | Jul 1, 2025 | $12,675 | $634 |
Premium and claims on this contract
DELTA DENTAL OF WISCONSIN, contract 10717 00000. For the contract year on this filing, the carrier reported $71,119 in premium earned and $46,123 in claims incurred. Dividing one by the other gives 65%.
- DELTA DENTAL OF WISCONSIN, contract 10717 00000 reported $17,492 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. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 185 employees, 0 recordable cases, 0 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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