| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS LLC | 4200 UNIVERSITY AVE STE 200 WEST DES MOINES, IA 50266 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 7.50% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS LLC | 4200 UNIVERSITY AVE., STE 200 WEST DES MOINES, IA 50266 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | $2K | — | $2K | 10.00% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: LMC INSURANCE & RISK MANAGEMENT | 4200 UNIVERSITY AVE., STE 200 WEST DES MOINES, IA 50266 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | $0 | — | $0 | 0.00% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS LLC | 4200 UNIVERSITY AVE., STE. 200 WEST DES MOINES, IA 50266 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 15.00% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS | 4200 UNIVERSITY AVE STE 200 WEST DES MOINES, IA 50266 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $662 | — | $662 | 15.01% |
| WILLIAM D CARLSON3 | 1533 RAEDEL RD EAU CLAIRE, WI 54703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.80% |
| EMPLOYEE BENEFIT ADVANTAGES INC3 | 14740 BOWERS DR. NW RAMSEY, MN 55303 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.16% |
| CIGNA3 Filed as: CIGNA GROUP INSURANCE | PO BOX 20643 LEHIGH VALLEY, PA 180020643 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | — | $0 | 0.00% |
No Schedule C service providers reported on this filing.
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 | 294 | 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) | 294 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | 130 | $25K |
| Life insurance(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 294 | $25K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 3 | $1K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 63 | $44K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 294 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 294 | — |
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.