| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OUTSOURCE/CIELOSTAR3 | 730 2ND AVENUE SOUTH SUITE 530 MINNEAPOLIS, MN 53402 | FUSION | $52K | — | $52K | 10.00% |
| WISCONSIN INSURANCE BROKERAGE LLC3 | 3326 S 47TH ST GREENFIELD, WI 53219 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 2.55% |
| WISCONSIN INSURANCE BROKERAGE LLC3 | 3326 S 47TH ST GREENFIELD, WI 53219 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $639 | $639 | 1.86% |
| WISCONSIN INSURANCE BROKERAGE LLC3 | 3326 S 47TH ST GREENFIELD, WI 53219 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $853 | $853 | 2.72% |
| WISCONSIN INSURANCE BROKERAGE LLC3 | 3326 S 47TH ST GREENFIELD, WI 53219 | WSSTA INSURANCE COMPANY INC | $2K | — | $2K | 9.15% |
| FMLA SOURCE INC5 | 455 N CITYFRONT PLZ DR 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $5K | $5K | 84.78% |
| WISCONSIN INSURANCE BROKERAGE LLC3 | 3326 S 47TH STREET GREENFIELD, WI 53219 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $918 | — | $918 | 15.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $160 | $160 | 2.62% |
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 | 207 | 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) | 207 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | WSSTA INSURANCE COMPANY INC | 139 | $19K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 285 | $6K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 147 | $52K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 132 | $31K |
| Stop-loss / reinsurancereinsurance | FUSION | 192 | $522K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 285 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 285 | — |
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.