| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI LLC. - WI ABRC | 711 EISENHOWER DR KIMBERLY, WI 54136 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $2K | — | $2K | 10.00% |
| ZILAY MARK 64545S3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | KANSAS CITY LIFE INSURANCE COMPANY | $1K | — | $1K | 8.82% |
| DAVID J VANDEHEY3 | 311 E ANN STREET STE 2 KAUKAUNA, WI 541303970 | PRINCIPAL LIFE INSURANCE COMPANY | $445 | — | $445 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 NONE | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $73K |
| BAKER TILLY US, LLP EIN 39-0859910 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $17K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $9K |
| OPTUMRX, INC. EIN 33-0441200 PHARMACY BENEFIT MANAGER | Other fees; Claims processing; Float revenue; Direct payment from the plan Service code 12 | — | $0 |
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 | 132 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 136 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | 144 | $16K |
| Life insurance(2 contracts, 2 carriers) | KANSAS CITY LIFE INSURANCE COMPANY | 159 | $18K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 137 | $538K |
| Other | KANSAS CITY LIFE INSURANCE COMPANY | 159 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 159 | — |
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.
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.