| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES, INC. | N14W23900 STONE RIDGE DR. WAUKESHA, WI 53188 | HCC LIFE INSURANCE COMPANY | $8K | — | $8K | 5.00% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES, INC. | PO BOX 1610 WAUKESHA, WI 53187 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 6.99% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES, INC. | N14W23900 STONE RIDGE DR. WAUKESHA, WI 531881135 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | $945 | — | $945 | 10.15% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $77K |
| R&R INSURANCE SERVICES EIN 39-1230987 BROKER | Other commissions Service code 55 | W239 N3490 STONE RIDGE DRIVE WAUKESHA, WI 53188 | $11K |
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $2K |
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 | 102 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | HCC LIFE INSURANCE COMPANY | 109 | $460K |
| Dental | DELTA DENTAL OF WISCONSIN | 83 | $71K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | 68 | $9K |
| Stop-loss / reinsurancereinsurance(2 contracts) | HCC LIFE INSURANCE COMPANY | 109 | $460K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 109 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.