| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES INC | N14W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | UNITEDHEALTHCARE INSURANCE COMPANY | $7K | $3K | $10K | 3.62% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES INC | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $307 | $3K | 15.69% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES INC | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $230 | $21 | $251 | 5.95% |
| PEDERSEN ASSOCIATES LTD3 | 360 EAST DAPHNE ROAD FOX POINT, WI 53217 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $25 | $0 | $25 | 0.59% |
| ASSUREX3 | 175 SOUTH 3RD STREET, SUITE 800 COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $17 | $17 | 0.40% |
No Schedule C service providers reported on this filing.
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) | UNITEDHEALTHCARE INSURANCE COMPANY | 45 | $284K |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 45 | $284K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 45 | $284K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 102 | $18K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 12 | $4K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 102 | $18K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 45 | $284K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 102 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 102 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.