| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | $657 | $3K | 2.71% |
| WATCHTOWER BENEFITS, LLC3 Filed as: WATCHTOWER TECHNOLOGIES INC | 306 W. ERIE STREET, SUITE #300 CHICAGO, IL 60654 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $2K | $2K | 2.21% |
| C2 CENTRIC LLC3 | PO BOX 6824 GRAND RAPIDS, MI 49516 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $487 | $487 | 0.44% |
| DELLA M OTRADOVEC3 | 2520 SAINT ANN DR GREEN BAY, WI 54311 | AFLAC | $2K | $3K | $6K | 8.97% |
| CHRISTINE A VANDENBERG3 | 819 S BUCHANAN ST APPLETON, WI 54915 | AFLAC | $3K | $921 | $4K | 6.28% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | AFLAC | $3K | — | $3K | 4.76% |
| WILLIAM C HAGEN3 | 258 CORPORATE DR STE 200 MADISON, WI 53714 | AFLAC | $898 | $136 | $1K | 1.65% |
| PAUL W DESPIRITO3 | 3051 PROGRESS WAY STE 204 KAUKAUNA, WI 54130 | AFLAC | $837 | $137 | $974 | 1.55% |
| SAMANTHA J LEITERITZ3 | 3051 PROGRESS WAY STE 204 KAUKAUNA, WI 54130 | AFLAC | $575 | — | $575 | 0.92% |
| KARLY MELINA ADAMSON3 | 843 SOUTH ST PLYMOUTH, WI 53073 | AFLAC | $458 | $97 | $555 | 0.88% |
| HCM BENEFITS SERVICES LLC3 | 540 UNIVERSITY AVE STE 50 PALO ALTO, CA 94301 | AFLAC | $317 | — | $317 | 0.51% |
| ASSUREDPARTNERS3 Filed as: DIMOND BROS INSURANCE LLC | 118 E COLUMBIAN BLVD N LITCHFIELD, IL 62056 | AFLAC | $285 | — | $285 | 0.45% |
| BRITTANY A MCCULLEY3 | 15101 OLD IRISH RD REEDSVILLE, WI 54230 | AFLAC | $254 | — | $254 | 0.40% |
| JAMIE R LAUENSTEIN3 | 15 S WALNUT ST MAYVILLE, WI 53050 | AFLAC | $184 | $7 | $191 | 0.30% |
| SHAMROCK SYNERGY SOLUTIONS LLC3 | 644 OHIO RIVER BLVD SEWICKLEY, PA 15143 | AFLAC | $56 | — | $56 | 0.09% |
No Schedule C service providers reported on this filing.
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 | 193 | 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) | 193 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC | 127 | $15K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 200 | $174K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 200 | $111K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 200 | $111K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 200 | $174K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 200 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.