| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EUCLID INSURANCE SERVICES INC5 | 234 SPRING LAKE DR ITASCA, IL 60143 | METROPOLITAN LIFE INSURANCE COMPANY | — | $4K | $4K | 5.77% |
| CARPENTER ROWLAND BATENBURG CO INC3 | 500 WISCONSIN AVE RACINE, WI 53403 | METROPOLITAN LIFE INSURANCE COMPANY | -$1K | — | -$1K | -2.12% |
| JENNON CARUTH3 | 7825 WASHINGTON AVE S STE 710 MINNEAPOLIS, MN 55439 | METROPOLITAN LIFE INSURANCE COMPANY | -$5K | — | -$5K | -7.50% |
| CARPENTER ROWLAND BATENBURG CO INC3 | 500 WISCONSIN AVE RACINE, WI 53403 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | — | $12K | 17.14% |
| EUCLID INSURANCE SERVICES INC5 | 234 SPRING LAKE DR ITASCA, IL 60143 | METROPOLITAN LIFE INSURANCE COMPANY | — | $8K | $8K | 12.32% |
| CARPENTER ROWLAND BATENBURG CO INC3 Filed as: CARPENTER ROWLAND BATENBURG | 500 WISCONSIN AVE 1ST FL RACINE, WI 53403 | WYSSTA INSURANCE COMPANY INC | $4K | — | $4K | 8.00% |
| JENNON CARUTH3 | 7825 WASHINGTON AVE S STE 710 MINNEAPOLIS, MN 55439 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | — | $4K | 8.96% |
| EUCLID INSURANCE SERVICES INC5 | 234 SPRING LAKE DR ITASCA, IL 60143 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 5.78% |
| CARPENTER ROWLAND BATENBURG CO INC3 | 500 WISCONSIN AVE RACINE, WI 53403 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 4.46% |
| JENNON CARUTH3 | 7825 WASHINGTON AVE S STE 710 MINNEAPOLIS, MN 55439 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 10.73% |
| EUCLID INSURANCE SERVICES INC5 | 234 SPRING LAKE DR ITASCA, IL 60143 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 6.26% |
| CARPENTER ROWLAND BATENBURG CO INC3 | 500 WISCONSIN AVE RACINE, WI 53403 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 6.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX,INC EIN 33-0441200 PHARMACY BENEFIT MGMT | Other fees; Claims processing; Direct payment from the plan; Float revenue Service code 12 | — | $916K |
| UMR,INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $294K |
| LOCKTON COMPANIES,LLC EIN 20-3354970 BROKER | Other commissions Service code 55 | — | $124K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $18K |
| THE HEALTH PLAN OF THE UPPER OHIO EIN 55-0585592 RECORDKEEPING | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $12K |
| CARPENTER ROWLAND BATENBURG INSURANCE AGENT/BROKER | Insurance agents and brokers Service code 22 | 500 WISCONSIN AVE 1ST FL RACINE, WI 53403 | $5K |
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 | 513 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 519 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | METROPOLITAN LIFE INSURANCE COMPANY | 239 | $41K |
| Vision | WYSSTA INSURANCE COMPANY INC | 280 | $51K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 493 | $68K |
| Short-term disability(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 205 | $97K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 493 | $68K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 356 | $785K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 493 | $103K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 493 | — |
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.