Form 5500 · Employee benefit plan · MERRILL, WI
WEINBRENNER SHOE COMPANY, INC.
The filing calls this plan WEINBRENNER SHOE COMPANY, INC. SALARIED AND OFFICE HOURLY GROUP INSURANCE PLAN.
Public Form 5500 records show how WEINBRENNER SHOE COMPANY, INC. of MERRILL, WI, a manufacturing employer, structures its employee benefits. Its broker of record is HUB INTERNATIONAL MIDWEST LTD. Coverage is written through BLUE CROSS & BLUE SHIELD OF WISCONSIN and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 39-1597573 · plan 502 · plan year 2023, filed May 17, 2024
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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
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 4 insured contracts covering health, dental and vision; the largest, with BLUE CROSS & BLUE SHIELD OF WISCONSIN, covers 315 people.
Reported premium across the insured contracts is $2,615,268, with $55,231 in disclosed broker commissions — about 2.1% 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.
HUB INTERNATIONAL MIDWEST LTD is the broker of record on 2 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including BLUE CROSS & BLUE SHIELD OF WISCONSIN, COMPCARE HEALTH SERVICES INSURANCE CORPORATION, DELTA DENTAL OF WISCONSIN and WYSSTA INSURANCE COMPANY INC. BLUE CROSS & BLUE SHIELD OF WISCONSIN writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS & BLUE SHIELD OF WISCONSIN | Health | 315 | Jan 1, 2024 | $1,262,482 | $24,329 |
| COMPCARE HEALTH SERVICES INSURANCE CORPORATION | Health | 315 | Jan 1, 2024 | $1,262,482 | $24,328 |
| DELTA DENTAL OF WISCONSIN | Dental | 129 | Jan 1, 2024 | $67,662 | $4,275 |
| WYSSTA INSURANCE COMPANY INC | Dental, Vision | 181 | Jan 1, 2024 | $22,642 | $2,299 |
Premium and claims on this contract
DELTA DENTAL OF WISCONSIN, contract 01621 00000. For the contract year on this filing, the carrier reported $67,662 in premium earned and $27,012 in claims incurred. Dividing one by the other gives 40%.
- DELTA DENTAL OF WISCONSIN, contract 01621 00000 reported $14,133 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.
Other plans filed by this employer
How this plan compares
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