| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VITI FINANCIAL SERVICES INC3 | 445 SHERIDAN RD HIGHWOOD, IL 60040 | BLUE CROSS & BLUE SHIELD OF WISCONSIN | $31K | — | $31K | 2.56% |
| VITI FINANCIAL SERVICES INC3 | 445 SHERIDAN RD HIGHWOOD, IL 60040 | DELTA DENTAL OF WISCONSIN | $4K | — | $4K | 5.17% |
| VITI FINANCIAL SERVICES INC3 | 2222 CHESTNUT AVE STE 305 GLENVIEW, IL 66026 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| WORKSITE STRATEGY GROUP LLC3 | 302 MONROE ST APT 4B HOBIKEN, NJ 07030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $863 | $863 | 5.00% |
| THE WORKSITE GROUP LLC5 | 1900 POLARIS PKWY STE 450 COLUMBUS, OH 43240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $863 | $863 | 5.00% |
| VITI FINANCIAL SERVICES INC3 | 2222 CHESTNUT AVE STE 305 GLENVIEW, IL 66026 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| WORKSITE STRATEGY GROUP LLC3 | 302 MONROE ST APT 4B HOBIKEN, NJ 07030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $752 | $752 | 5.00% |
| THE WORKSITE GROUP LLC5 | 1900 POLARIS PKWY STE 450 COLUMBUS, OH 43240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $752 | $752 | 5.00% |
| VITI FINANCIAL SERVICES INC3 | 2222 CHESTNUT AVE STE 305 GLENVIEW, IL 66026 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| WORKSITE STRATEGY GROUP LLC3 | 302 MONROE ST APT 4B HOBIKEN, NJ 07030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $663 | $663 | 5.00% |
| THE WORKSITE GROUP LLC5 | 1900 POLARIS PKWY STE 450 COLUMBUS, OH 43240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $663 | $663 | 5.00% |
| VITI FINANCIAL SERVICES INC3 | 2222 CHESTNUT AVE STE 305 GLENVIEW, IL 66026 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| WORKSITE STRATEGY GROUP LLC3 | 302 MONROE ST APT 4B HOBIKEN, NJ 07030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $545 | $545 | 5.00% |
| VITI FINANCIAL SERVICES INC3 | 2222 CHESTNUT AVE STE 305 GLENVIEW, IL 66026 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| WORKSITE STRATEGY GROUP LLC3 | 302 MONROE ST APT 4B HOBIKEN, NJ 07030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $388 | $388 | 5.00% |
| THE WORKSITE GROUP LLC5 | 1900 POLARIS PKWY STE 450 COLUMBUS, OH 43240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $388 | $388 | 5.00% |
| THE WORKSITE GROUP LLC3 | 1900 POLARIS PKWY STE 450 COLUMBUS, OH 43240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 39.00% |
| VITI FINANCIAL SERVICES INC3 | 2222 CHESTNUT AVE STE 305 GLENVIEW, IL 66026 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 25.99% |
| WORKSITE STRATEGY GROUP LLC3 | 302 MONROE ST APT 4B HOBIKEN, NJ 07030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $366 | — | $366 | 5.00% |
| THE WORKSITE GROUP LLC3 | 1900 POLARIS PKWY STE 450 COLUMBUS, OH 43240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 39.00% |
| VITI FINANCIAL SERVICES INC3 | 2222 CHESTNUT AVE STE 305 GLENVIEW, IL 66026 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 26.00% |
| WORKSITE STRATEGY GROUP LLC3 | 302 MONROE ST APT 4B HOBIKEN, NJ 07030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $306 | — | $306 | 4.99% |
| THE WORKSITE GROUP LLC3 | 1900 POLARIS PKWY STE 450 COLUMBUS, OH 43240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 39.00% |
| VITI FINANCIAL SERVICES INC3 | 2222 CHESTNUT AVE STE 305 GLENVIEW, IL 66026 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 26.01% |
| WORKSITE STRATEGY GROUP LLC3 | 302 MONROE ST APT 4B HOBIKEN, NJ 07030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $306 | — | $306 | 5.00% |
| VITI FINANCIAL SERVICES INC3 | 2222 CHESTNUT AVE STE 305 GLENVIEW, IL 66026 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $669 | — | $669 | 15.00% |
| WORKSITE STRATEGY GROUP LLC3 | 302 MONROE ST APT 4B HOBIKEN, NJ 07030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $223 | $223 | 5.00% |
| THE WORKSITE GROUP LLC5 | 1900 POLARIS PKWY STE 450 COLUMBUS, OH 43240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $223 | $223 | 5.00% |
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 | 265 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 265 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS & BLUE SHIELD OF WISCONSIN | 80 | $1.2M |
| Dental | DELTA DENTAL OF WISCONSIN | 110 | $74K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 95 | $11K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 265 | $28K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 41 | $17K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 25 | $12K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 265 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 265 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.