| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC3 Filed as: R&R INSURANCE SERVIES INC. | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $418 | $418 | 1.25% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES INC. | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $208 | $3K | 16.22% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES INC. | PO BOX 1610 WAUKESHA, WI 531871610 | WYSSTA INSURANCE COMPANY INC. | $974 | — | $974 | 8.03% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES INC. | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $205 | $9 | $214 | 3.78% |
| ASSUREX3 | 175 SOUTH 3RD STREET, SUITE 800 COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $7 | $7 | 0.12% |
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 | 188 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 194 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC. | 97 | $12K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 192 | $50K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 192 | $33K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 192 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 192 | — |
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.