| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCHWARZ INSURANCE AGENCY INC3 Filed as: SCHWARZ INSURANCE AGENCY | 1420 NORTH RIDGE DR PRAIRIE DU SAC, WI 53578 | QUARTZ HEALTH BENEFITS PLAN CORPORATION | $24K | — | $24K | 2.39% |
| SCHWARZ INSURANCE AGENCY INC3 Filed as: SCHWARZ INSURANCE AGENCY | 1420 NORTH RIDGE DR PRAIRIE DU SAC, WI 53578 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 11.25% |
| GROUP INSURANCE SERVICES INC3 | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 3.75% |
| SCHWARZ INSURANCE AGENCY INC3 | 1420 NORTH RIDGE DR PRAIRIE DU SAC, WI 53578 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 15.00% |
| GROUP INSURANCE SERVICES INC3 | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 5.00% |
| SCHWARZ INSURANCE AGENCY INC3 Filed as: SCHWARZ INSURANCE AGENCY | 1420 NORTH RIDGE DR PRAIRIE DU SAC, WI 53578 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 11.25% |
| GROUP INSURANCE SERVICES INC3 | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 3.75% |
| SCHWARZ INSURANCE AGENCY INC3 Filed as: SCHWARZ INSURANCE AGENCY | 1420 NORTH RIDGE DR PRAIRIE DU SAC, WI 53578 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| GROUP INSURANCE SERVICES INC3 | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $739 | — | $739 | 5.00% |
| SCHWARZ INSURANCE AGENCY INC3 Filed as: SCHWARZ INSURANCE AGENCY | 1420 NORTH RIDGE DR PRAIRIE DU SAC, WI 535781092 | AMERITAS LIFE INSURANCE CORP. | $958 | — | $958 | 9.01% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 604502215 | AMERITAS LIFE INSURANCE CORP. | $531 | $391 | $922 | 8.68% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | — | $7K |
| EMPLOYEE BEEFITS CORPORATION EIN 39-2044064 | Claims processing; Contract Administrator Service code 12 | — | $5K |
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 | 196 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 196 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | AMERITAS LIFE INSURANCE CORP. | 180 | $11K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 196 | $57K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 196 | $33K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 196 | $38K |
| Prescription drug | QUARTZ HEALTH BENEFITS PLAN CORPORATION | 232 | $1.0M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 196 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 232 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.