| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: SUN LIFE ASSURANCE COMPANY OF CANAD | ONE SUN LIFE EXECUTIVE PARK WEILLESLEY HILLS, MA 02481 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | — | $0 | 0.00% |
| TIC INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | DELTA DENTAL OF WISCONSIN | $6K | — | $6K | 8.43% |
| TIC INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $2K | $10K | 19.90% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 3.26% |
| TIC INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $978 | $4K | 19.45% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $652 | $652 | 2.96% |
| TIC INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $806 | $3K | 19.55% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $538 | $538 | 3.04% |
| TIC INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | WYSSTA INSURANCE COMPANY INC. | $887 | — | $887 | 8.00% |
| TIC INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $468 | $2K | 19.27% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $312 | $312 | 2.85% |
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 | 176 | 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) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 138 | $76K |
| Vision | WYSSTA INSURANCE COMPANY INC. | 103 | $11K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 177 | $33K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 104 | $49K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 75 | $18K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 125 | $250K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 177 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 177 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.