| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI LLC. - WI ABRC | P.O. BOX 62817 VIRGINIA BEACH, VA 23466 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $1K | — | $1K | 10.00% |
| ZILAVY MARK 64545S3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | KANSAS CITY LIFE INSURANCE COMPANY | $1K | — | $1K | 9.68% |
| DAVID J VANDEHEY3 | 311 E ANN STREET STE 2 KAUKAUNA, WI 541303970 | PRINCIPAL LIFE INSURANCE COMPANY | $409 | — | $409 | 10.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - WI | 711 EISENHOWER DR. KIMBERLY, WI 54136 | DELTA DENTAL OF WISCONSIN | $678 | $0 | $678 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 NONE | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $38K |
| BAKER TILLY US, LLP EIN 39-0859910 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $18K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $7K |
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 | 117 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 96 | $0 |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | 246 | $12K |
| Life insurance(2 contracts, 2 carriers) | KANSAS CITY LIFE INSURANCE COMPANY | 117 | $15K |
| Other | KANSAS CITY LIFE INSURANCE COMPANY | 117 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 246 | — |
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.