| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | HUMANA WISCONSIN HEALTH ORG INS CORP | $24K | $1K | $25K | 2.06% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC-WI | 711 EISENHOWER DR KIMBERLY, WI 541360000 | DELTA DENTAL OF WISCONSIN | $4K | — | $4K | 6.12% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | P O BOX 66119 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE INSURANCE COMPANY | $8K | $544 | $9K | 16.38% |
| USI INSURANCE SERVICES LLC3 Filed as: USI LLC. - WI ABRC | PO BOX 62817 VIRGINIA BEACH, VA 23466 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $989 | — | $989 | 4.63% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM LIFE INSURANCE COMPANY EIN 35-0980405 CLAIMS PROCESSING | Contract Administrator; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $4K |
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 | 111 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA WISCONSIN HEALTH ORG INS CORP | 81 | $1.2M |
| Dental | DELTA DENTAL OF WISCONSIN | 85 | $58K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | 159 | $21K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 111 | $54K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 111 | $54K |
| 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."
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.