| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF WISCONSIN | $19K | $0 | $19K | 9.41% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 245 SOUTH EXECUTIVE DRIVE SUITE 200 BROOKFIELD, WI 53005 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $764 | $7K | 5.57% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $8K | $0 | $8K | 10.84% |
| ASSOCIATED FINANCIAL GROUP LLC3 Filed as: ASSOCIATED FINANCIAL GROUP | UNKNOWN KIMBERLY, WI 54136 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $4 | $0 | $4 | 0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 245 SOUTH EXECUTIVE DRIVE SUITE 200 BROOKFIELD, WI 53005 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $24 | $1K | 15.31% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, INC. | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $0 | $1K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | FOUR EVER LIFE INSURANCE COMPANY | $187 | $19 | $206 | 5.51% |
| ANTHEM INSURANCE COMPANIES, INC.3 | 120 MONUMENT CIRCLE INDIANAPOLIS, IN 46204 | FOUR EVER LIFE INSURANCE COMPANY | $187 | $19 | $206 | 5.51% |
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 | 354 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 363 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | FOUR EVER LIFE INSURANCE COMPANY | 354 | $4K |
| Dental | DELTA DENTAL OF WISCONSIN | 256 | $200K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 1,069 | $73K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 354 | $134K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 354 | $134K |
| Other(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 354 | $145K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,069 | — |
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.