| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R&R INS SER INC3 | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORAT | $25K | $708 | $26K | 3.61% |
| R&R INS SER INC3 | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | HUMANA INSURANCE COMPANY | $3K | $590 | $4K | 7.21% |
| R & R INSURANCE SERVICES INC3 | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $746 | $6K | 13.02% |
| R & R INSURANCE SERVICES INC3 | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $341 | $3K | 15.50% |
| CARUTH, JENNON, M3 | 7825 WASHINGTON AVENUE SOUTH SUITE 710 BLOOMINGTON, MN 55439 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $87 | $1K | 12.47% |
| R & R INSURANCE SERVICES INC3 | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $559 | $41 | $600 | 6.12% |
| BLOCK, CHARLES, D3 | 648 VILLAGE PARK DRIVE UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $24 | — | $24 | 0.24% |
| VAN EPPS, JAMES, H3 | 10930 CRABAPPLE ROAD SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $24 | — | $24 | 0.24% |
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 | 72 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 74 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORAT | 79 | $714K |
| Dental | HUMANA INSURANCE COMPANY | 74 | $49K |
| Vision | HUMANA INSURANCE COMPANY | 74 | $49K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 146 | $64K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 146 | $43K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 146 | $43K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 146 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 146 | — |
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.