| 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 | $30K | $342 | $30K | 3.88% |
| R & R INSURANCE SERVICES INC3 | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $1K | $8K | 11.75% |
| R&R INS SER INC3 | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | HUMANA INSURANCE COMPANY | $4K | $347 | $4K | 6.97% |
| CARUTH, JENNON, M3 | 7825 WASHINGTON AVENUE SOUTH SUITE 710 BLOOMINGTON, MN 55439 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $672 | $39 | $711 | 8.16% |
| R & R INSURANCE SERVICES INC3 | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $339 | $19 | $358 | 4.11% |
| BLOCK, CHARLES, D3 | 648 VILLAGE PARK DRIVE UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $26 | — | $26 | 0.30% |
| VAN EPPS, JAMES, H3 | 10930 CRABAPPLE ROAD SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $26 | — | $26 | 0.30% |
| JENNON M CARUTH3 Filed as: JENNON M. CARUTH | 7825 WASHINGTON AVE SE STE 710 BLOOMINGTON, MN 55439 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $118 | $2K | 56.96% |
| R & R INSURANCE SERVICES INC3 | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $805 | $56 | $861 | 24.67% |
| ASSUREX3 | 175 SOUTH 3RD STREET STE 800 COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $47 | $47 | 1.35% |
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 | 205 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 206 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORAT | 91 | $774K |
| Dental | HUMANA INSURANCE COMPANY | 92 | $62K |
| Vision | HUMANA INSURANCE COMPANY | 92 | $62K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 205 | $71K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 205 | $67K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 205 | $67K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 205 | $76K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 205 | — |
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.