| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 SO. 8TH ST. STE. 700 MINNEAPOLIS, MN 55402 | QUARTZ HEALTH BENEFIT PLANS | $25K | — | $25K | 4.64% |
| BENEFIT SERVICES GROUP, INC.3 Filed as: THE BENEFIT SERVICES GROUP | N25 W23050 PAUL RD. PEWAUKEE, WI 53072 | QUARTZ HEALTH BENEFIT PLANS | $2K | — | $2K | 0.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF WI EIN 39-0138065 NONE | Float revenue; Other fees; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing Service code 12 | — | $525K |
| WISCONSIN COLLABORATIVE INSURANCE C EIN 47-5569628 NONE | Contract Administrator; Claims processing; Other fees; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $349K |
| BLUE CROSS BLUE SHIELD OF WISCONSIN | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | — | $217K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 NONE | Contract Administrator; Insurance services; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 13 | — | $74K |
| DISCOVERY BENEFITS EIN 90-0058554 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $35K |
| VISION SERVICE PLAN EIN 06-1227840 NONE | Contract Administrator; Direct payment from the plan; Insurance agents and brokers; Claims processing; Insurance brokerage commissions and fees; Other commissions Service code 12 | — | $27K |
| CVS PHARMACY, INC. EIN 05-0340626 NONE | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $18K |
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 | 2,642 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 632 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,282 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS | 84 | $538K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS | 84 | $538K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF WISCONSIN | 2,552 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,552 | — |
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.