| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AVERGENT LLC3 Filed as: AVERGENT | 1400 LOMBARDI AVE STE 40 GREEN BAY, WI 54304 | DELTA DENTAL OF WISCONSIN | $9K | — | $9K | 5.47% |
| AVERGENT LLC3 Filed as: AVERGENT | 1400 LOMBARDI AVE STE 40 GREEN BAY, WI 54304 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 10.00% |
| AVERGENT LLC3 Filed as: AVERGENT | 1400 LOMBARDI AVE STE 40 GREEN BAY, WI 54304 | WYSSTA INSURANCE COMPANY INC | $1K | — | $1K | 8.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AITHER HEALTH LLC EIN 84-2273042 INSURANCE SERVICES | Insurance services Service code 23 | — | $64K |
| AVERGENT CONSULTING EIN 83-3367624 INS AGENTS AND BROKERS | Insurance agents and brokers Service code 22 | — | $50K |
| THE ALLIANCE/TRILOGY, NOVO, FIRST EIN 39-1675538 INSURANCE SERVICES | Insurance services Service code 23 | — | $36K |
| COLLABORATE CARE ASSISTANT EIN 20-1834524 DIRECT PAYMENT FROM PLAN | Direct payment from the plan Service code 50 | — | $34K |
| MEDXOOM EIN 47-4302152 INSURANCE SERVICES | Insurance services Service code 23 | — | $9K |
| MEMD, LEGACY MEDICAL SERVICE EIN 46-3279589 DIRECT PAYMENT FROM PLAN | Direct payment from the plan Service code 50 | — | $8K |
| PAYER COMPASS EIN 46-2047081 INSURANCE SERVICES | Insurance services Service code 23 | — | $7K |
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $6K |
| CASE MANAGEMENT SPECIALISTS EIN 61-1688248 INSURANCE SERVICES | Insurance services Service code 23 | — | $5K |
| POINDEXTER EIN 20-3424289 OTHER FEES | Other fees Service code 99 | — | $2K |
| FIDUCIARY RISK MANAGEMENT (FRM) EIN 47-4131554 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $6 |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 178 | $157K |
| Vision | WYSSTA INSURANCE COMPANY INC | 140 | $14K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 75 | $37K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 75 | $37K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 75 | $37K |
| Stop-loss / reinsurancereinsurance | UME | 316 | $307K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 75 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 316 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.