| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | PO BOX 51187 NEW BERLIN, WI 53151 | DELTA DENTAL OF WISCONSIN | $4K | — | $4K | 6.19% |
| ACRISURE LLC3 Filed as: HNI RISK SERVICES LLC - ACRISURE LL | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 10.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $146 | $2K | 5.41% |
| ACRISURE LLC3 Filed as: HNI RISK SERVICES LLC - ACRISURE LL | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $7K | — | $7K | 29.41% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $122 | $1K | 5.52% |
| ACRISURE LLC3 Filed as: HNI RISK SERVICES LLC - ACRISURE LL | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 6.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $993 | $124 | $1K | 5.62% |
| ACRISURE LLC3 Filed as: HNI RISK SERVICES LLC - ACRISURE LL | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 29.43% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $614 | $64 | $678 | 5.52% |
| ACRISURE LLC3 Filed as: HNI RISK SERVICES LLC - ACRISURE LL | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 29.54% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $505 | $45 | $550 | 5.44% |
| ACRISURE LLC3 | PO BOX 51187 NEW BERLIN, WI 53151 | WYSSTA INSURANCE COMPANY INC | $747 | — | $747 | 8.01% |
| ACRISURE LLC3 Filed as: HNI RISK SERVICES LLC - ACRISURE LL | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $405 | — | $405 | 10.01% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $202 | $13 | $215 | 5.32% |
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 | 177 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 138 | $63K |
| Vision | WYSSTA INSURANCE COMPANY INC | 114 | $9K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 172 | $40K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 177 | $20K |
| Other(5 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 172 | $90K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 177 | — |
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.