| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: BENEFIT ALLIANT LLC | P.O. BOX 11267 MILWAUKEE, WI 53211 | BLUE CROSS BLUE SHIELD OF WISCONSIN | $46K | $0 | $46K | 3.22% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES, INC. | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | BLUE CROSS BLUE SHIELD OF WISCONSIN | $0 | $361 | $361 | 0.03% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: BENEFIT ALLIANT LLC | P.O. BOX 11267 MILWAUKEE, WI 53211 | COMPCARE HEALTH SERVICES INSURANCE CORPORATION | $6K | $0 | $6K | 2.79% |
| VIZANCE, INC.3 | 1320 WALNUT RIDGE DRIVE SUITE 200 HARTLAND, WI 53029 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 7.87% |
| VIZANCE, INC.3 | 1320 WALNUT RIDGE DRIVE SUITE HARTLAND, WI 53029 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 16.00% |
| VIZANCE, INC.3 | 1320 WALNUT RIDGE DRIVE SUITE 200 HARTLAND, WI 53029 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $2K | $0 | $2K | 7.08% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $707 | $0 | $707 | 2.91% |
| VIZANCE, INC.3 | 1320 WALNUT RIDGE DRIVE SUITE 200 HARTLAND, WI 53029 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $198 | $0 | $198 | 10.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | 2801 HOOVER ROAD STEVENS POINT, WI 54481 | $10K |
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 | 190 | 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) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF WISCONSIN | 160 | $1.6M |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | 158 | $24K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 190 | $2K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 190 | $51K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 190 | $19K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 190 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.