| 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 | $11K | — | $11K | 5.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT PLAN ADMINISTRATION OF WI EIN 39-1401001 NONE | Plan Administrator; Other services; Direct payment from the plan Service code 14 | — | $1.4M |
| CAREATC EIN 73-1598062 NONE | Direct payment from the plan; Other services Service code 49 | — | $1.1M |
| UNITED HEALTHCARE INSURANCE CO. EIN 36-2739571 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $775K |
| LEE JOST & ASSOCIATES EIN 39-1401001 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $70K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 NONE | Direct payment from the plan; Claims processing; Contract Administrator Service code 12 | — | $70K |
| AURORA HEALTHCARE EIN 39-1442285 NONE | Direct payment from the plan; Insurance services Service code 23 | — | $70K |
| BUILDING TRADES UNITED PENSION FUND EIN 51-6049409 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $54K |
| U.S. BANK N.A. EIN 31-0841368 NONE | Direct payment from the plan; Investment management Service code 28 | — | $43K |
| ZELIS CLAIMS INTEGRITY INC. NONE | Direct payment from the plan; Claims processing Service code 12 | 2 CROSSROADS DRIVE BEDMINSTER, NJ 07921 | $36K |
| UMR NONE | Direct payment from the plan; Other services Service code 49 | PO BOX 88822 MILWAUKEE, WI 532880822 | $25K |
| THE PREVIANT LAW FIRM S.C. EIN 39-1211596 NONE | Legal; Direct payment from the plan Service code 29 | — | $19K |
| FREYBERG HINKLE ASHLAND POWERS & ST EIN 39-1531945 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $14K |
| 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; Direct payment from the plan Service code 12 | — | $9K |
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 | 1,647 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 628 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,275 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CARE PLUS DENTAL PLANS, INC. | 983 | $291K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,712 | $203K |
| Other | NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA | 1,769 | $280K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,769 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.