| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CARPENTER ROWLAND BATENBURG CO INC3 | 500 WISCONSIN AVE RACINE, WI 53403 | METROPOLITAN LIFE INSURANCE COMPANY | $9K | — | $9K | 10.52% |
| EUCLID INSURANCE SERVICES INC5 | 234 SPRING LAKE DR ITASCA, IL 60143 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $6K | $6K | 6.81% |
| JENNON CARUTH3 | 6400 FLYING CLOUD DR STE 215 EDEN PRAIRIE, MN 55344 | METROPOLITAN LIFE INSURANCE COMPANY | $25K | — | $25K | 38.35% |
| CARPENTER ROWLAND BATENBURG CO INC3 | 500 WISCONSIN AVE RACINE, WI 53403 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | — | $11K | 16.44% |
| EUCLID INSURANCE SERVICES INC5 | 234 SPRING LAKE DR ITASCA, IL 60143 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $3K | $3K | 4.21% |
| CRB INSURANCE3 | 500 WISCONSIN AVE 1ST FL RACINE, WI 53403 | WYSSTA INSURANCE COMPANY INC | $3K | — | $3K | 8.00% |
| JENNON CARUTH3 | 6400 FLYING CLOUD DR STE 215 EDEN PRAIRIE, MN 55344 | METROPOLITAN LIFE INSURANCE COMPANY | $14K | $263 | $15K | 38.76% |
| CARPENTER ROWLAND BATENBURG CO INC3 | 500 WISCONSIN AVE RACINE, WI 53403 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | — | $4K | 11.51% |
| EUCLID INSURANCE SERVICES INC5 | 234 SPRING LAKE DR ITASCA, IL 60143 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $2K | $2K | 4.18% |
| JENNON CARUTH3 | 6400 FLYING CLOUD DR STE 215 EDEN PRAIRIE, MN 55344 | METROPOLITAN LIFE INSURANCE COMPANY | $10K | $585 | $11K | 43.96% |
| CARPENTER ROWLAND BATENBURG CO INC3 | 500 WISCONSIN AVE RACINE, WI 53403 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | — | $4K | 17.81% |
| EUCLID INSURANCE SERVICES INC5 | 234 SPRING LAKE DR ITASCA, IL 60143 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $1K | $1K | 4.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX,INC EIN 33-0441200 PHARMACY BENEFIT MGMT | Other fees; Float revenue; Claims processing; Direct payment from the plan Service code 12 | — | $576K |
| UMR,INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $304K |
| LOCKTON COMPANIES,LLC EIN 20-3354970 BROKER | Other commissions Service code 55 | — | $115K |
| THE HEALTH PLAN OF THE UPPER OHIO EIN 55-0585592 RECORDKEEPING | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $24K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $15K |
| CRB INSURANCE INSURANCE AGENT/BROKER | Insurance agents and brokers Service code 22 | 500 WISCONSIN AVE 1ST FL RACINE, WI 53403 | $4K |
| OPTUMRX, INC. | Other fees; Claims processing; Direct payment from the plan; Float revenue 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 | 444 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 444 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 297 | $62K |
| Vision | WYSSTA INSURANCE COMPANY INC | 244 | $43K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 166 | $88K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 145 | $64K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 166 | $88K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 342 | $558K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 342 | $137K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 342 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.