Form 5500 · Employee benefit plan · STOUGHTON, WI
STOUGHTON HOSPITAL ASSOCIATION
The filing calls this plan STOUGHTON HOSPITAL ASSOCIATION GROUP HEALTH AND WELFARE WRAP PLAN.
Public Form 5500 records show how STOUGHTON HOSPITAL ASSOCIATION of STOUGHTON, WI, a health care and social assistance employer, structures its employee benefits. Its broker of record is TRICOR INSURANCE. Coverage is written through QUARTZ HEALTH BENEFIT PLANS CORPORATION and 5 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 39-0832914 · plan 510 · plan year 2024, filed Jul 30, 2025
Get an email when this employer files a new Form 5500, and again about four months before its plan renews.
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
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: 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 10 insured contracts covering health, dental, vision, life and disability; the largest, with QUARTZ HEALTH BENEFIT PLANS CORPORATION, covers 240 people.
Reported premium across the insured contracts is $4,049,659, with $77,847 in disclosed broker commissions — about 1.9% 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.
TRICOR INSURANCE is the broker of record on 1 of the 10 contracts; the rest name a different broker or none.
6 carriers appear on the filing, including QUARTZ HEALTH BENEFIT PLANS CORPORATION, DEAN HEALTH PLAN INC, DELTA DENTAL OF WISCONSIN and UNITED OF OMAHA LIFE INSURANCE COMPANY. QUARTZ HEALTH BENEFIT PLANS CORPORATION writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| QUARTZ HEALTH BENEFIT PLANS CORPORATION | Health | 240 | Jan 1, 2025 | $1,812,428 | $23,015 |
| DEAN HEALTH PLAN INC | Health | 224 | Jan 1, 2025 | $1,632,394 | $22,412 |
| DELTA DENTAL OF WISCONSIN | Dental | 278 | Jan 1, 2025 | $212,514 | $9,040 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 126 | Jan 1, 2025 | $57,670 | $6,760 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 307 | Jan 1, 2025 | $203,338 | $6,267 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 158 | Jan 1, 2025 | $67,991 | $4,680 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 307 | Jan 1, 2025 | $43,176 | $3,659 |
| WYSSTA INSURANCE COMPANY INC | Vision | 94 | Jan 1, 2025 | $11,587 | $1,052 |
| MUTUAL OF OMAHA INSURANCE COMPANY | — | 66 | Jan 1, 2025 | $6,425 | $642 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 10 | Jan 1, 2025 | $2,136 | $320 |
Premium and claims on this contract
DELTA DENTAL OF WISCONSIN, contract 01212 00000. For the contract year on this filing, the carrier reported $211,581 in premium earned and $172,798 in claims incurred. Dividing one by the other gives 82%.
- DELTA DENTAL OF WISCONSIN, contract 01212 00000 reported $35,992 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: 372 employees, 9 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
Subscribers see how this compares with similar plans in Wisconsin. A subscription also adds this plan's filing history and the renewal calendar for its state. See plans and prices
Without an account you can open 10 employer, broker and carrier pages a day, including through an AI assistant, and 50 a day with a free account. Paid plans are what keep these records free to read.
Renewal calendar
1,633 other employer plans in Wisconsin are January 1 renewals (policy year ends December).
Their policy years end in December, like this plan’s, so most renew January 1. The calendar lists every insured group by renewal date and state, with broker of record, carrier and disclosed commission. You can preview the five largest in each month for free.
Claude & ChatGPT
Look up records from Claude or ChatGPT
Add Form5500Lookup to Claude or ChatGPT and ask about any employer, broker or carrier in plain English. Lookups are free. Renewal lists, full books of business and exports are included with a subscription.
Building a list or a tool from these records? Match a list you already have from $29 per 1,000 records, or license the whole dataset as a weekly file for $499 a month. See both
More employer plans in Wisconsin — largest plans, brokers, carriers and renewal months.