| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R&R INSURANCE3 | N14 W23900 STONE RIDGE DR WAUKESHA, WI 53188 | THE HARTFORD | $2K | — | $2K | 1.09% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMPCARE HEALTH SERVICES INSURANCE EIN 39-1462554 TPA SERVICES AND FEES | Claims processing; Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $137K |
| DELTA DENTAL OF WI EIN 39-6094742 DENTAL TPA | Contract Administrator Service code 13 | — | $14K |
| INGENIORX, INC EIN 82-3062245 RX REBATES & FEES | Claims processing; Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $0 |
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 | 336 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 343 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS BLUE SHIELD | 229 | $0 |
| Vision | SUPERIOR VISION PLAN | 331 | $26K |
| Life insurance | THE HARTFORD | 309 | $175K |
| Short-term disability | THE HARTFORD | 309 | $175K |
| Long-term disability | THE HARTFORD | 309 | $175K |
| Prescription drug | ANTHEM BLUE CROSS BLUE SHIELD | 229 | $0 |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE HCC - STOP LOSS GROUP | 239 | $554K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 331 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.