| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R & R INSURANCE SERVICES INC3 | N14W23900 STONE RIDGE DR WAUKESHA, WI 531881135 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | — | $4K | 6.61% |
| R & R INSURANCE SERVICES INC3 | N14W23900 STONE RIDGE DR WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 14.30% |
| R & R INSURANCE SERVICES INC3 | N14W23900 STONE RIDGE DR WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $855 | $3K | 21.68% |
| R & R INSURANCE SERVICES INC3 | N14W23900 STONE RIDGE DR WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $374 | $241 | $615 | 16.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| VITORI EIN 85-4253126 CLAIMS PROCESSING | Claims processing; Other insurance fees and expenses Service code 12 | — | $28K |
| SELF FUND HEALTH EIN 84-4739592 CLAIMS PROCESSING | Claims processing; Other insurance fees and expenses Service code 12 | — | $11K |
| R + R INSURANCE SERVICES, INC. INS AGENTS AND BROKERS | Insurance agents and brokers Service code 22 | N14W23900 STONE BRIDGE DR WAUKESHA, WI 53188 | $11K |
| TRILOGY HEALTH SOLUTIONS, INC. EIN 36-4016705 CLAIMS PROCESSING | Claims processing; Other insurance fees and expenses Service code 12 | — | $8K |
| MEDWATCH LLC EIN 16-1662117 CLAIMS PROCESSING | Claims processing; Other insurance fees and expenses Service code 12 | — | $4K |
| DIVERSIFIED BENEFIT SERVICES CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | 625 WALNUT RIDGE DR # 190 HARTLAND, WI 53029 | $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 | 115 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 115 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 127 | $59K |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 127 | $59K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 127 | $59K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $4K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 111 | $35K |
| Stop-loss / reinsurancereinsurance | TPAC UNDERWRITERS | 96 | $377K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 127 | — |
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."
No prospect flags tripped on this filing.