| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $42K | — | $42K | 15.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $14K | $14K | 4.84% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 54136 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $12K | $12K | 4.53% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $6K | — | $6K | 2.26% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $12K | $12K | 5.07% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | — | $5K | 2.06% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC-WI | 711 EISENHOWER DR KIMBERLY, WI 54136 | WYSSTA INSURANCE COMPANY INC | $9K | — | $9K | 8.37% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC-WI | 711 EISENHOWER DR. KIMBERLY, WI 54136 | WYSSTA INSURANCE COMPANY INC | $1K | — | $1K | 8.31% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $384 | — | $384 | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $861K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 TPA (DENTAL BENEFIT) | Contract Administrator Service code 13 | — | $63K |
| USI INSURANCE SERVICES LLC INS AGENT OR BROKER | Insurance agents and brokers Service code 22 | 711 EISENHOWER DR KIMBERLY, WI 54136 | $27K |
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 | 2,060 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 17 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 89 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,166 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision(2 contracts) | WYSSTA INSURANCE COMPANY INC | 981 | $123K |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,060 | $515K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,003 | $255K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE-BENEFIT MALL | 1,607 | $1.3M |
| Other(3 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,380 | $518K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,380 | — |
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.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.