| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INSURANCE SERVICES,LLC | 318 S. WASHINGTON ST, STE 200 GREEN BAY, WI 54301 | UNITED HEALTH CARE INSURACE COMPANY | $11K | — | $11K | 9.43% |
| JOHNSON INS SERVICES LLC3 | 555 MAIN STREET STE 291 RACINE, WI 53403 | UNION SECURITY INSURANCE COMPANY | $169 | — | $169 | 0.21% |
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INSURANCE SERVICES, LLC | 555 MAIN STREET, STE 291 RACINE, WI 53403 | NATIONAL VISION ADMINISTRATORS, LLC | $2K | — | $2K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | 10701 WEST RESEARCH DRIVE MILWAUKEE, WI 53226 | $138K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator; Insurance agents and brokers Service code 13 | 2801 HOOVER ROAD STEVENS POINT, WI 54481 | $16K |
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 | 391 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 394 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 395 | $38K |
| Life insurance | UNITED HEALTH CARE INSURACE COMPANY | 391 | $116K |
| Short-term disability | UNION SECURITY INSURANCE COMPANY | 393 | $79K |
| Long-term disability | UNITED HEALTH CARE INSURACE COMPANY | 391 | $116K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 395 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.