| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROGUS, EVE3 | 1115 TAYLOR AVE SUITE 112 GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $33K | — | $33K | 1.98% |
| CLARK THEILIG3 | 7402 STONE BRIDGE DR, SUITE #3 WESTON, WI 54476 | WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION | $47K | — | $47K | 3.00% |
| ASSOCIATED FINANCIAL GROUP LLC3 Filed as: ASSOCIATED FINANCIAL GROUP | 711 EISENHOWER DR KIMBERLY, WI 54136 | HARTFORD LIFE AND ACCIDENT | $48K | — | $48K | 6.00% |
| ASSOCIATED FINANCIAL GROUP LLC3 | P O BOX 640 GREEN BAY, WI 543050640 | HARTFORD LIFE AND ACCIDENT | — | $19K | $19K | 2.41% |
| PLAN BENEFIT ANALYSTS OF TULSA INC3 Filed as: PLAN BENEFIT ANALYSIS OF TULSA, INC | SOUTHERN WOODS PARK 4775 E 91ST ST , SUITE 200 TULSA, OK 741372805 | COMMUNITY CARE | $17K | — | $17K | 2.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LIMITED P | 5314 S YALE SUITE 900 TULSA, OK 74135 | COMMUNITY CARE | $8K | — | $8K | 1.14% |
| BB&T INSURANCE SERVICES, INC.3 Filed as: BB & T INSURANCE SERVICES | 414 GALLIMORE DAIRY RS S GREENSBORO, NC 27409 | OPTIMA HEALTH INSURANCE COMPANY | $19K | — | $19K | 2.70% |
| BB&T INSURANCE SERVICES, INC.3 Filed as: BB & T INSURANCE SERVICES INC | 1020 DRAYTON STREET, 2ND FLOOR STE 200 SAVANAH, GA 31401 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 3.98% |
| SVIHOVEC, DEBRA3 | 12600 WHITEWATER DRIVE, SUITE 100 HOPKINS, MN 55343 | HEALTH PARTNERS | $9K | — | $9K | 16.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL PLAN BENEFIT ANAL | 4775 E 91ST ST , STE 200 TULSA, OK 741372805 | DELTA DENTAL | $3K | — | $3K | 8.00% |
| ROGUS, EVE3 | 1115 TAYLOR AVE, SUITE 112 GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $119 | — | $119 | 1.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITEDHEALTHCARE EIN 36-2739571 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $1.2M |
| BLUE ADVANTAGE EIN 71-0226428 NONE | Claims processing Service code 12 | — | $175K |
| SISCO EIN 42-1144827 NONE | Claims processing Service code 12 | — | $67K |
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 | 2,840 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 511 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,351 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(8 contracts, 7 carriers) | PRIORITY HEALTH | 387 | $5.5M |
| Dental(3 contracts, 3 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 87 | $154K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 3,327 | $807K |
| Prescription drug(5 contracts, 4 carriers) | PRIORITY HEALTH | 370 | $4.7M |
| Other | HARTFORD LIFE AND ACCIDENT | 3,327 | $807K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,327 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.