Form 5500 · Employee benefit plan · APPLETON, WI
VAN VREEDE TV & APPLIANCE, INC.
The filing calls this plan VAN VREEDE TV & APPLIANCE, INC. WELFARE BENEFIT PLAN.
VAN VREEDE TV & APPLIANCE, INC. of APPLETON, WI is a 101-participant retail employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is MCCLONE AGENCY INC. Coverage is written through HEALTHPARTNERS INSURANCE COMPANY and 3 other carriers. The plan's most recent policy period ended in September.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 39-1186226 · plan 501 · plan year 2025, filed Sep 24, 2026
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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.
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 4 insured contracts covering health, dental, vision, life and disability; the largest, with HEALTHPARTNERS INSURANCE COMPANY, covers 119 people.
Reported premium across the insured contracts is $747,231, with $6,718 in disclosed broker commissions — about 0.9% of premium.
The most recent policy period ended in September, and the plan year ends September 30. Group contracts typically renew on that annual cycle.
MCCLONE AGENCY INC is the broker of record on all 4 contracts.
4 carriers appear on the filing, including HEALTHPARTNERS INSURANCE COMPANY, DELTA DENTAL OF WISCONSIN, HARTFORD LIFE AND ACCIDENT and SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC.. HEALTHPARTNERS INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| DELTA DENTAL OF WISCONSIN | Dental | 71 | Oct 1, 2025 | $44,883 | $3,380 |
| HARTFORD LIFE AND ACCIDENT | Life, Disability | 101 | Oct 1, 2025 | $16,589 | $2,488 |
| SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | Vision | 81 | Oct 1, 2025 | $8,479 | $850 |
| HEALTHPARTNERS INSURANCE COMPANY | Health | 119 | Oct 1, 2025 | $677,280 | $0 |
Premium and claims on this contract
DELTA DENTAL OF WISCONSIN, contract 7908. For the contract year on this filing, the carrier reported $44,883 in premium earned and $24,010 in claims incurred. Dividing one by the other gives 53%.
- DELTA DENTAL OF WISCONSIN, contract 7908 reported $11,128 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.
Reported to OSHA
Reported to OSHA for 2025: 110 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
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