| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SBR SERVICES LLC3 | 2300 WINDY RIDGE PKWY SUITE 695S ATLANTA, GA 30339 | HCC LIFE INSURANCE COMPANY | $11K | — | $11K | 1.53% |
| SBR SERVICES LLC3 | 2839 PACES FERRY ROAD SE SUITE 830 ATLANTA, GA 30339 | HCC LIFE INSURANCE COMPANY | $11K | — | $11K | 1.47% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 | 1933 STATE ROUTE 35, SUITE 368 WALL, NJ 07719 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | $2K | $15K | 5.02% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 | 1933 STATE ROUTE 35 SUITE 368 WALL, NJ 07719 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | $1K | $7K | 4.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEEST LTD | 55 E JACKSON BLVD CHCIAGO, IL 606040000 | WYSSTA INSURANCE COMPANY INC | $4K | — | $4K | 8.21% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN & ASSOCIATRES LLC | 1933 STATE ROUTE 35, SUITE 368 WALL, NJ 07719 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $584 | $152 | $736 | 4.84% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $329K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $26K |
| RXBENEFITS, INC. EIN 63-1157085 CLAIMS PROCESSING | Claims processing Service code 12 | — | $6K |
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 | 697 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 713 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC | 391 | $48K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,273 | $295K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 696 | $12K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 696 | $142K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | TOKIO MARINE | 603 | $1.5M |
| Other(5 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,273 | $337K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,273 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.