| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASR HEALTH BENEFITS3 | P.O. BOX 6392 3033 ORCHARD VISTA S.E. GRAND RAPIDS, MI 49516 | SIRIUS AMERICA | $6K | $0 | $6K | 3.00% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $804 | $4K | 11.65% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $496 | $4K | 17.18% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $381 | $3K | 16.77% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $289 | $2K | 12.29% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 140 MONROE CTR ST NW STE 200 GRAND RAPIDS, MI 495032893 | VISION SERVICE PLAN | $741 | $0 | $741 | 6.91% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $237 | $2K | 17.54% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES LLC | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $809 | $116 | $925 | 17.15% |
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 | 142 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SIRIUS AMERICA | 115 | $198K |
| Vision | VISION SERVICE PLAN | 66 | $11K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 52 | $23K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 142 | $35K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 142 | $17K |
| Stop-loss / reinsurancereinsurance | SIRIUS AMERICA | 115 | $198K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 142 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 142 | — |
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.