Form 5500 · Employee benefit plan · PLEASANT PRAIRIE, WI
THE OLDS PRODUCTS CO. OF ILLINOIS
The filing calls this plan THE OLDS PRODUCTS CO. OF ILLINOIS EMPLOYEE BENEFITS PLAN.
THE OLDS PRODUCTS CO. OF ILLINOIS of PLEASANT PRAIRIE, WI files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is BJORK GROUP INC. Coverage is written through CIGNA HEALTH AND 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 36-1577920 · plan 501 · plan year 2024, filed Jun 25, 2025
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How this plan is funded
Self-funded as reported
The filing reports a stop-loss contract and no medical premium, which is what a plan that pays its own claims reports.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
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 2 insured contracts covering dental, vision, life, disability and stop-loss; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 174 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.
The only insured piece of the health benefit is stop-loss coverage, and the filing reports the plan paying its own claims. The stop-loss contract reports $582,686 in premium and $101,199 in commission. The rest of the premium and commission above is on the plan's other insured lines, and none of it is medical premium.
Reported premium across the insured contracts is $648,113, with $114,608 in disclosed broker commissions — about 18% 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.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Stop-loss | 174 | Jan 1, 2025 | $582,686 | $101,199 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Vision, Life, Disability | 189 | Sep 1, 2024 | $65,427 | $13,409 |
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.
Other plans filed by this employer
How this plan compares
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