| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JERRY VANNESS3 | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | BLUE CROSS OF CALIFORNIA | $31K | — | $31K | 3.74% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: WORD & BROWN INSURANCE ADMINISTRATO | 721 SOUTH PARKER STREET ORANGE, CA 92868 | BLUE CROSS OF CALIFORNIA | — | $17K | $17K | 2.00% |
| BENEFITSPRO INC3 | W6845 SOUTH SHORE DRIVE DELAVAN, WI 53115 | BLUE CROSS OF CALIFORNIA | $11K | — | $11K | 1.29% |
| JERRY W VAN NESS3 | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $12K | — | $12K | 5.62% |
| JERRY W VAN NESS3 | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $7K | — | $7K | 5.60% |
| JERRY W VAN NESS3 Filed as: JERRY VAN NESS | 529 FREE CHURCH DRIVE WILLIANS BAY, WI 53191 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | — | $6K | 6.32% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: WORD & BROWN INS ADMIN | 721 SOUTH PARKER STREET SUITE 200 ORANGE, CA 92868 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $764 | $6K | 5.71% |
| BENEFITSPRO INC3 | W6845 SHOUTH SHORE DRIVE DELAVAN, WI 53115 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 3.24% |
| JERRY W VAN NESS3 | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $2K | — | $2K | 5.42% |
| JERRY WILLIAMS VAN NESS3 | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 9.93% |
| BRANDON PENKO3 | 4927 MAGNOLIA BEND DRIVE ROSHARON, TX 77583 | TRUSTMARK INSURANCE COMPANY | $1K | — | $1K | 18.54% |
| JERRY W VAN NESS3 Filed as: JERRY VAN NESS | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | TRUSTMARK INSURANCE COMPANY | $486 | — | $486 | 7.25% |
| BENEFITSPRO INC3 | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | TRUSTMARK INSURANCE COMPANY | $47 | — | $47 | 0.70% |
| BRANDON PENKO3 | 4927 MAGNOLIA BEND DRIVE ROSHARON, TN 77583 | TRUSTMARK INSURANCE COMPANY | $599 | — | $599 | 9.86% |
| JERRY W VAN NESS3 Filed as: JERRY VAN NESS | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | TRUSTMARK INSURANCE COMPANY | $229 | — | $229 | 3.77% |
| BENEFITSPRO INC3 Filed as: BENEFITSPRO INC. | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | TRUSTMARK INSURANCE COMPANY | $28 | — | $28 | 0.46% |
| BRANDON PENKO3 | 4927 MAGNOLIA BEND DRIVE ROSHARON, TX 77583 | TRUSTMARK INSURANCE COMPANY | $498 | — | $498 | 11.92% |
| JERRY W VAN NESS3 Filed as: JERRY VAN NESS | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | TRUSTMARK INSURANCE COMPANY | $172 | — | $172 | 4.12% |
| BENEFITSPRO INC3 | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | TRUSTMARK INSURANCE COMPANY | $41 | — | $41 | 0.98% |
| BRANDON PENKO3 | 4927 MAGNOLIA BEND DRIVE ROSHARON, TX 77583 | TRUSTMARK INSURANCE COMPANY | $611 | — | $611 | 15.09% |
| JERRY W VAN NESS3 Filed as: JERRY VAN NESS | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | TRUSTMARK INSURANCE COMPANY | $201 | — | $201 | 4.97% |
| BENEFITSPRO INC3 | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | TRUSTMARK INSURANCE COMPANY | $58 | — | $58 | 1.43% |
| JERRY W VAN NESS3 Filed as: JERRY VAN NESS | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION | $248 | — | $248 | 6.89% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: WORD & BROWN INS ADMIN | 721 SOUTH PARKER STREET SUITE 200 ORANGE, CA 92868 | SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION | $179 | $54 | $233 | 6.48% |
| BENEFITSPRO INC3 | W6845 SHOUTH SHPORE DRIVE DELAVAN, WI 53115 | SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION | $110 | — | $110 | 3.06% |
| JERRY W VAN NESS3 Filed as: JERRY VAN NESS | 529 FREE CHURCH DRIVE WILLIAMS BAY, WI 53191 | LANDMARK HEALTHPLAN | $336 | — | $336 | 10.00% |
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 | 144 | 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) | 144 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 46 | $1.2M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 209 | $106K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 209 | $102K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 144 | $43K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 144 | $36K |
| Other(6 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 144 | $61K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 209 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.