| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHNSON INSURANCE SERVICES LLC3 | 14 SHADE TREE COURT MADISON, WI 53717 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | $1K | $8K | 11.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRAIRIE STATES ENTERPRISES, INC. EIN 36-3730559 THIRD PARTY ADMINISTRATO | Contract Administrator; Claims processing Service code 12 | 402 N MICHIGAN AVE SUITE 2902 CHICAGO, IL 60611 | $55K |
| EMPLOYER HEALTH CARE ALLIANCE EIN 39-1675538 ADMINISTRATOR | Plan Administrator Service code 14 | 5510 NOBEL DRIVE SUITE 200 FITCHBURG, WI 53711 | $26K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATO | Contract Administrator Service code 13 | 2801 HOOVER RD PO BOX 828 STEVENS POINT, WI 54481 | $6K |
| JOHNSON INSURANCE SERVICES LLC EIN 56-2435265 INSURANCE AGENT OR BROKE | Insurance agents and brokers Service code 22 | 14 SHADE TREE COURT MADISON, WI 53717 | $53 |
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 | 172 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 182 | $77K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 182 | $77K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 182 | $77K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 182 | $77K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 182 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.