| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | N27 W23960 PAUL ROAD PEWAUKEE, WI 53072 | ANTHEM BCBS OF WISCONSIN | $32K | — | $32K | 14.89% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | N27 W23960 PAUL ROAD PEWAUKEE, WI 53072 | LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 5.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BCBS OF WISCONSIN EIN 39-1038065 THIRD PARTY ADMINISTRATOR | Float revenue; Contract Administrator; Other fees; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | N17W24340 RIVERWOOD DRIVE WAUKESHA, WI 53188 | $124K |
| CIGNA BEHAVIORAL HEALTH EIN 41-1648670 ADMINISTER EAP | Contract Administrator; Claims processing; Participant communication; Direct payment from the plan Service code 12 | ONE PENN WAY NEW CASTLE, DE 19720 | $3K |
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 | 146 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 146 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYE MED VISION | 251 | $15K |
| Life insurance | LIFE INSURANCE COMPANY OF AMERICA | 140 | $87K |
| Short-term disability | LIFE INSURANCE COMPANY OF AMERICA | 140 | $87K |
| Long-term disability | LIFE INSURANCE COMPANY OF AMERICA | 140 | $87K |
| Stop-loss / reinsurancereinsurance | ANTHEM BCBS OF WISCONSIN | 304 | $216K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 304 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.