| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENJAMIN SMITH3 | 12065 W. JANESVILLE ROAD SUITE 200 MUSKEGO, WI 53150 | THE PRUDENTIAL INSURANCE COMPANY | — | $11 | $11 | 1.38% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GREAT-WEST LIFE & ANNUITY COMPANY RECORDKEEPER | Recordkeeping fees Service code 64 | 8515 EAST ORCHARD ROAD GREENWOOD VILLAGE, CO 80111 | $35K |
| DENALI WEALTH MANAGEMENT- CARL VALI INVESTMENT ADVISOR | Investment advisory (plan) Service code 27 | 4425 N PORT WASHINGTON RD STE 105 MILWAUKEE, WI 53212 | $31K |
| HARBOUR INVESTMENTS INC INVESTMENT ADVISOR | Investment advisory (plan) Service code 27 | 575 DONOFRIO DR STE 300 MADISON, WI 537192832 | $4K |
| EMPOWER RETIREMENT ADVISORY SERVICE INVESTMENT MGMT | Investment management Service code 28 | 8515 EAST ORCHARD ROAD GREENWOOD VILLAGE, CO 80111 | $4K |
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 | 359 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 59 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 418 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY | 1 | $797 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.