| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 300 N BEACH ST DAYTONA BEACH, FL 32114 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $22K | — | $22K | 1.25% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 S 8TH STREET STE 700 MINNEAPOLIS, MN 55402 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $3K | — | $3K | 0.14% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS SVCS INC | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | DELTA DENTAL OF WISCONSIN | $6K | — | $6K | 5.45% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS SVCS INC | 5250 CORPORATE DR STE 200 TROY, MI 48098 | AMERICAN FIDELITY ASSURANCE COMPANY | $3K | — | $3K | 14.52% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WI INC | 1062 OAK FOREST DR STE 120 ONALASKA, WI 54650 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 9.04% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP OF WI LLC | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $135 | $135 | 0.76% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WI INC | 1062 OAK FOREST DR STE 120 ONALASKA, WI 54650 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 20.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS SVCS INC | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $146 | $146 | 0.88% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WI INC | 1062 OAK FOREST DR STE 120 ONALASKA, WI 54650 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS SVCS INC | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $114 | $114 | 0.71% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WI INC | 1062 OAK FOREST DR STE 120 ONALASKA, WI 54650 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS SVCS INC | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $139 | $139 | 0.96% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS SVCS INC | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | WYSSTA INSURANCE COMPANY INC | $1K | — | $1K | 8.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WI INC | 1062 OAK FOREST DR STE 120 ONALASKA, WI 54650 | GUNDERSEN CLINIC, LTD | $0 | — | $0 | 0.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF WI INC | 1062 OAK FOREST DR STE 120 ONALASKA, WI 54650 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $128 | — | $128 | 15.06% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS SVCS INC | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $8 | $8 | 0.94% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 | Contract Administrator; Claims processing Service code 12 | PO BOX 44347 MADISON, WI 53744 | $6K |
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 | 230 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 230 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 230 | $1.8M |
| Dental | DELTA DENTAL OF WISCONSIN | 144 | $104K |
| Vision | WYSSTA INSURANCE COMPANY INC | 93 | $14K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 158 | $18K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 29 | $16K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 230 | $1.8M |
| Other(5 contracts, 3 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 300 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 300 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.