| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITOL SPECIAL RISKS3 | 1000 PARKWOOD CIR, STE 925 ATLANTA, GA 30339 | SUN LIFE ASSURANCE COMPANY OF CANADA | $16K | — | $16K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE INSURANCE CO. EIN 36-2739571 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $794K |
| BENEFIT PLAN ADMINISTRATION OF WI EIN 39-1401001 NONE | Plan Administrator; Other services; Direct payment from the plan Service code 14 | — | $766K |
| LEE JOST & ASSOCIATES EIN 39-1401001 NONE | Consulting (general); Direct payment from the plan; Contract Administrator Service code 13 | — | $385K |
| GREATBANC TRUST COMPANY EIN 36-3681493 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $82K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $75K |
| AURORA HEALTHCARE EIN 39-1442285 NONE | Direct payment from the plan; Insurance services Service code 23 | — | $60K |
| BUILDING TRADES UNITED PENSION FUND EIN 51-6049409 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $45K |
| GLOBALCARE INC. NONE | Direct payment from the plan; Claims processing Service code 12 | DEPT AT 952968 ATLANTA, GA 311922968 | $26K |
| SCHENCK S.C. EIN 39-1173131 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $19K |
| COMBINED CRAFTS EIN 39-1401001 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $12K |
| SERVE YOU CUSTOM PRESCRIPTION MGMT EIN 39-1735466 NONE | Claims processing Service code 12 | — | $7K |
| EVALUATIONS PLUS INC. EIN 68-0248524 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $7K |
| THE PREVIANT LAW FIRM S.C. EIN 39-1211596 NONE | Legal; Direct payment from the plan Service code 29 | — | $6K |
| U.S. BANKCORP N.A. EIN 31-0841368 NONE | Direct payment from the plan; Investment management Service code 28 | — | $41 |
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 | 1,440 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 627 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,067 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CARE PLUS DENTAL PLANS, INC. | 922 | $270K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,593 | $159K |
| Other | AIG BENEFIT SOLUTIONS | 1,593 | $296K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,593 | — |
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.