| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CYPRESS BENEFIT ADMINISTRATORS, LLC3 | 5560 W GRANDE MARKET DRIVE APPLETON, WI 54913 | INTERNATIONAL MEDICAL GROUP | $14K | $29K | $43K | 15.66% |
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INS | 318 S WASHINGTON ST STE 200 GREEN BAY, WI 54301 | INTERNATIONAL MEDICAL GROUP | — | $20K | $20K | 7.31% |
| HEALTH EOS3 | PO BOX 29940 NEW YORK, NY 10087 | INTERNATIONAL MEDICAL GROUP | — | $6K | $6K | 2.08% |
| AMERICAN HEALTH HOLDING3 | 7400 WEST CAMPUS ROAD NEW ALBANY, OH 43054 | INTERNATIONAL MEDICAL GROUP | — | $2K | $2K | 0.77% |
| ICR BRIDGE3 | 818 W RIVERSIDE STE. 800 SPOKANE, WA 99201 | INTERNATIONAL MEDICAL GROUP | — | $1K | $1K | 0.52% |
| PREMIER HEALTHCARE EXCHANGE3 | 2 CROSSROADS DRIVE BEDMINSTER, NJ 07921 | INTERNATIONAL MEDICAL GROUP | — | $76 | $76 | 0.03% |
| JOHNSON INSURANCE SERVICES LLC3 | 555 MAIN STREET STE 291 RACINE, WI 53403 | DELTA DENTAL OF WISCONSIN | $6K | — | $6K | 4.70% |
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INSURANCE SERVICES, LLC | 555 MAIN STREET SUITE 291 RACINE, WI 53403 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $11K | — | $11K | 12.43% |
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 | 165 | 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) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | INTERNATIONAL MEDICAL GROUP | 120 | $275K |
| Dental | DELTA DENTAL OF WISCONSIN | 139 | $126K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 165 | $85K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 165 | $85K |
| Long-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 165 | $85K |
| Prescription drug | INTERNATIONAL MEDICAL GROUP | 120 | $275K |
| Other | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 165 | $85K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 165 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.