| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R & R INSURANCE SERVICES INC3 | N14 W23900 STONE RIDGE DR WAUKESHA, WI 531880000 | DELTA DENTAL OF WISCONSIN | $3K | — | $3K | 6.27% |
| R & R INSURANCE SERVICES INC3 | N14W23900 STONE RIDGE DR WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 14.25% |
| R & R INSURANCE SERVICES INC3 | N14W23900 STONE RIDGE DR WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $576 | $3K | 19.10% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES INC | N14 W23900 STONE RIDGE DR WAUKESHA, WI 53188 | WYSSTA INSURANCE COMPANY INC | $697 | — | $697 | 8.72% |
| R & R INSURANCE SERVICES INC3 | N14W23900 STONE RIDGE DR WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $395 | $168 | $563 | 14.27% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| YUZU HEALTH INSURANCE SVCS, INC EIN 92-0678200 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $23K |
| SELF FUND HEALTH EIN 84-4739592 CLAIMS PROCESSING | Consulting (general); Direct payment from the plan Service code 16 | — | $12K |
| TRILOGY HEALTH SOLUTIONS, INC. EIN 46-4424095 CLAIMS PROCESSING | Claims processing Service code 12 | — | $8K |
| SOLSTICE HEALTH EIN 45-4734433 CLAIMS PROCESSING | Claims processing Service code 12 | — | $5K |
| MEDWATCH EIN 16-1662117 CLAIMS PROCESSING | Other insurance fees and expenses; 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 | 112 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 82 | $52K |
| Vision | WYSSTA INSURANCE COMPANY INC | 68 | $8K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 107 | $4K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $33K |
| Stop-loss / reinsurancereinsurance | PAN AMERICAN LIFE INSURANCE COMPANY | 65 | $394K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 107 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 107 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.