| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CYPRESS BENEFIT ADMINISTRATORS, LLC3 | 5560 W GRANDE MARKET DRIVE APPLETON, WI 54913 | INTERNATIONAL MEDICAL GROUP | $11K | $28K | $38K | 13.55% |
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INS | 318 S WASHINGTON ST STE 200 GREEN BAY, WI 54301 | INTERNATIONAL MEDICAL GROUP | — | $16K | $16K | 5.56% |
| ANSAY & ASSOCIATES LLC3 Filed as: ANSAY & ASSOCIATES | 101 E GRAND AVE SUITE 11 PORT WASHINGTON, WI 53074 | INTERNATIONAL MEDICAL GROUP | — | $5K | $5K | 1.93% |
| HEALTH EOS3 | PO BOX 29940 NEW YORK, NY 10087 | INTERNATIONAL MEDICAL GROUP | — | $4K | $4K | 1.38% |
| PREMIER HEALTHCARE EXCHANGE3 | 2 CROSSROADS DRIVE BEDMINSTER, NJ 07921 | INTERNATIONAL MEDICAL GROUP | — | $2K | $2K | 0.80% |
| AMERICAN HEALTH HOLDING3 | 7400 WEST CAMPUS ROAD NEW ALBANY, OH 43054 | INTERNATIONAL MEDICAL GROUP | — | $2K | $2K | 0.79% |
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INSURANCE | 555 MAIN STREET RACINE, WI 53403 | DELTA DENTAL OF WISCONSIN | $4K | — | $4K | 3.85% |
| ANSAY & ASSOCIATES LLC3 Filed as: ANSAY & ASSOCIATES | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 530740000 | DELTA DENTAL OF WISCONSIN | $1K | — | $1K | 1.29% |
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INSURANCE SERVICES, LLC | 555 MAIN STREET SUITE 291 RACINE, WI 53403 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $7K | $2K | $9K | 10.01% |
| ANSAY & ASSOCIATES LLC3 | 419 S WASHINGTON ST GREEN BAY, WI 54301 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 2.60% |
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 | 199 | 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) | 199 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | INTERNATIONAL MEDICAL GROUP | 130 | $282K |
| Dental | DELTA DENTAL OF WISCONSIN | 146 | $115K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 199 | $90K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 199 | $90K |
| Long-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 199 | $90K |
| Prescription drug | INTERNATIONAL MEDICAL GROUP | 130 | $282K |
| Other | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 199 | $90K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 199 | — |
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.