| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 1872 MID VALLEY DR DE PERE, WI 54115 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 4.86% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 1872 MID VALLEY DR DE PERE, WI 54115 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 9.97% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 1872 MID VALLEY DR DE PERE, WI 54115 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 8.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | C/O DIANA BUTTS 615 E BRITTON RD OKLAHOMA CITY, OK 73114 | 5STAR LIFE INSURANCE COMPANY | $205 | — | $205 | 23.95% |
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 | 500 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 511 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | BLUE CROSS BLUE SHIELD OF WISCONSIN | 802 | $570K |
| Life insurance(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 615 | $20K |
| Short-term disability | STANDARD INSURANCE COMPANY | 615 | $67K |
| Long-term disability | STANDARD INSURANCE COMPANY | 615 | $36K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF WISCONSIN | 802 | $570K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 802 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.