| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | PO BOX 51187 NEW BERLIN, WI 53151 | DELTA DENTAL OF WISCONSIN | $3K | — | $3K | 6.23% |
| ACRISURE LLC3 | PO BOX 51087 NEW BERLIN, WI 53151 | UNITEDHEALTHCARE INSURANCE COMPANY | $35 | — | $35 | 0.44% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 711 EISENHOWER KIMBERLY, WI 54136 | MAHATTANLIFE | $6 | — | $6 | 6.45% |
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 | 161 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 161 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 107 | $46K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 74 | $9K |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 161 | $8K |
| Other(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 161 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 161 | — |
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."
No prospect flags tripped on this filing.