| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FORSITE BENEFIT PARTNERS3 | 2300 RIVERSIDE DRIVE GREEN BAY, WI 54301 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $112 | $2K | 9.69% |
| THE HORTON GROUP3 | 10320 ORLAND PARKWAY ORLAND PARK, IL 60467 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $498 | $74 | $572 | 2.97% |
| FORSITE BENEFIT PARTNERS3 Filed as: FORSITE BENEFITS PARTNERS | 2300 RIVERSIDE DRIVE GREEN BAY, WI 54301 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $76 | $2K | 11.25% |
| THE HORTON GROUP3 | 10320 ORLAND PARKWAY ORLAND PARK, IL 60467 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $454 | $53 | $507 | 3.55% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE HORTON GROUP EIN 36-3672171 NONE | Insurance agents and brokers Service code 22 | 10320 ORLAND PARKWAY ORLAND PARK, IL 60467 | $6K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | — | $5K |
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 | 190 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA | 74 | $688K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | 121 | $12K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 190 | $19K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 190 | $19K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 190 | $34K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.