| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | PREVEA360 HEALTH PLAN | $21K | — | $21K | 1.51% |
| MICHAEL DAVID RUZEK3 Filed as: MICHAEL L TIEDT | 303 PACKERLAND DR STE C GREEN BAY, WI 54303 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $21K | $7K | $28K | 19.66% |
| SPECTRUM BENEFIT SOLUTION3 | 4233 SOUTHTOWNE DRIVE EAU CLAIRE, WA 54701 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $1K | — | $1K | 6.85% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $669 | — | $669 | 3.25% |
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 | 158 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREVEA360 HEALTH PLAN | 233 | $1.4M |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | 219 | $21K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 185 | $142K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 185 | $142K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 185 | $142K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 185 | $142K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 233 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
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.