| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JEFFREY A SCHULTZ3 Filed as: JEFFREY SHULTZ | 16805 W. CLEVLAND AVE NEW BERLIN, WI 53151 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $32K | — | $32K | 2.97% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $2K | — | $2K | 0.17% |
| JEFFREY A SCHULTZ3 Filed as: JEFFREY SHULTZ | 16805 W. CLEVLAND AVE NEW BERLIN, WI 53151 | BLUE CARE NETWORK OF MICHIGAN | $11K | — | $11K | 3.24% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE CARE NETWORK OF MICHIGAN | $624 | — | $624 | 0.19% |
| ACRISURE LLC3 | PO BOX 510187 NEW BERLIN, WI 53151 | HARTFORD LIFE AND ACCIDENT | $14K | — | $14K | 4.32% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 16805 W. CLEVELAND AVE NEW BERLIN, WI 53151 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5K | — | $5K | 10.02% |
| SHANNON A LADING3 | 738 W. FOURTH STREET APPLETON, WI 54914 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | — | $4K | 8.68% |
| PAUL GLOBAL BENEFITS INC3 Filed as: PAUL DESPIRITO | N 2892 HILL CREST DR HORTONVILLE, WI 54944 | CONTINENTAL AMERICAN INSURANCE COMPANY | $465 | — | $465 | 0.96% |
| CARRI POOL3 | 1609 COMMERCE DR NORTH MANKATO, MN 56003 | CONTINENTAL AMERICAN INSURANCE COMPANY | $149 | — | $149 | 0.31% |
| ADAM WICHMANN3 | 4362 N BULL RUSH DR APPLETON, WI 54913 | CONTINENTAL AMERICAN INSURANCE COMPANY | $82 | — | $82 | 0.17% |
| RANDA R ELLWANGER3 Filed as: RANDA R ELLEWAGNER | 3136 HILMGREN WAY GREEN BAY, WI 54304 | CONTINENTAL AMERICAN INSURANCE COMPANY | $62 | — | $62 | 0.13% |
| JASON SCZEPANIAK3 Filed as: JASON P SCZEPANIAK | 4001 FELLAND RD SUITE 106 MADISON, WI 53718 | CONTINENTAL AMERICAN INSURANCE COMPANY | $35 | — | $35 | 0.07% |
| ADAM THOMAS GARDNER3 Filed as: ADAM T GARDNER | 101 N. FARWELL STREET SUITE 203 EAU CLAIRE, WI 54703 | CONTINENTAL AMERICAN INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| CHRISTINE LOGSLETT3 Filed as: CHRISTINE M LOGSLETT | 300 N CORPORATE DRIVE STE 300 BROOKFIELD, WI 53045 | CONTINENTAL AMERICAN INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| JEREMY KOOI3 Filed as: JEREMY J KOOI | 3495 HUNTER HOLLOW RD DODGEVILLE, WI 53533 | CONTINENTAL AMERICAN INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| NICOLE D BLAKE3 | 1226 CULNER AVE NW BUFFALO, MN 53313 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| ROSS C NELSON3 | 1043 WIMBLETON WAY WAUNAKEE, WI 53597 | CONTINENTAL AMERICAN INSURANCE COMPANY | -$3 | — | -$3 | -0.01% |
| JEREMY KOOI3 | 304 W PARKVIEW ST COTTAGE GROVE, WI 53527 | CONTINENTAL AMERICAN INSURANCE COMPANY | -$3 | — | -$3 | -0.01% |
| ACRISURE LLC3 | PO BOX 51187 NEW BERLIN, WI 53151 | WYSSTA INSURANCE COMPANY INC | $3K | — | $3K | 8.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATO | Contract Administrator Service code 13 | — | $21K |
| ACRISURE LLC INSURANCE AGENT OR BROKE | Insurance agents and brokers Service code 22 | PO BOX 51187 NEW BERLIN, WI 53151 | $3K |
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 | 404 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 23 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 429 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 478 | $4.1M |
| Vision | WYSSTA INSURANCE COMPANY INC | 371 | $40K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 616 | $320K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 616 | $320K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 616 | $320K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 616 | $368K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 616 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.