| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAN R STAGE3 | 711 EISENHOWER DR KIMBERLY, WI 54136 | BLUE CROSS BLUE SHIELD OF MICHICAN | $18K | — | $18K | 3.20% |
| JAN R STAGE3 | 1 HILLCREST DR E CHARLESTON, WV 25311 | DELTA DENTAL OF MICHIGAN | $6K | — | $6K | 2.74% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | STANDARD INSURANCE COMPANY | $7K | — | $7K | 3.31% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | STANDARD INSURANCE COMPANY | $6K | — | $6K | 3.03% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | STANDARD INSURANCE COMPANY | $5K | — | $5K | 3.76% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 3.27% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | STANDARD INSURANCE COMPANY | $5K | — | $5K | 6.94% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 5.19% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 3.72% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 3.57% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | STANDARD INSURANCE COMPANY | $13K | — | $13K | 55.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | STANDARD INSURANCE COMPANY | $577 | — | $577 | 2.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other fees; Claims processing; Contract Administrator; Insurance services; Consulting (general) Service code 12 | — | $243K |
| JAN R STAGE INS AGENTS | Other fees; Insurance brokerage commissions and fees; Non-monetary compensation; Insurance agents and brokers; Other commissions Service code 22 | 711 EISENHOWER DR KIMBERLY, WI 54136 | $19K |
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 | 415 | 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) | 416 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MICHIGAN | 821 | $224K |
| Vision | STANDARD INSURANCE COMPANY | 377 | $45K |
| Life insurance | STANDARD INSURANCE COMPANY | 671 | $127K |
| Short-term disability | STANDARD INSURANCE COMPANY | 505 | $197K |
| Long-term disability | STANDARD INSURANCE COMPANY | 220 | $75K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHICAN | 654 | $552K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 821 | — |
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.