| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCHWARZ INSURANCE3 | 1420 N RIDGE DR PRAIRIE DU SAC, WI 53578 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $22K | — | $22K | 1.46% |
| SCHWARZ INSURANCE AGENCY INC3 Filed as: SCHWARZ INSURANCE AGENCY, INC | 1420 NORTH RIDGE DRIVE PRAIRIE DU SAC, WI 53578 | SUN LIFE ASSURANCE COMPANY OF CANADA | $14K | — | $14K | 11.79% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES, INC | PO BOX 901 NAPERVILLE, IL 60566 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | — | $6K | 4.91% |
| SCHWARZ INSURANCE AGENCY INC3 Filed as: SCHWARZ INSURANCE AGENCY | 1420 NORTH RIDGE DRIVE PO BOX 40 PRAIRIE DU SAC, WI 53578 | NATIONAL GUARDIAN LIFE INSRANCE COMPANY | $1K | — | $1K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATO | Contract Administrator Service code 13 | — | $6K |
| SCHWARZ INSURANCE INS AGENTS AND BROKERS | Insurance agents and brokers Service code 22 | 1420 N RIDGE DR PRAIRIE DU SAC, WI 53578 | $765 |
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 | 124 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 198 | $1.5M |
| Vision | NATIONAL GUARDIAN LIFE INSRANCE COMPANY | 77 | $11K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 129 | $119K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 129 | $119K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 129 | $119K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 198 | $1.5M |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 129 | $119K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 198 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.