| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BRANDON MONDLOCK3 | T.I.C., INC 3301 GOLF RD STE 101 EAU CLAIRE, WI 547010000 | DELTA DENTAL OF WISCONSIN | $497 | — | $497 | 0.23% |
| BRANDON MONDLOCK3 | T.I.C., INC., 3301 GOLF RD STE 101 EAU CLAIRE, WI 547010000 | DELTA DENTAL OF WISCONSIN | $224 | — | $224 | 0.42% |
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 | 631 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 631 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | DELTA DENTAL OF WISCONSIN | 324 | $272K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC. | 735 | $36K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 631 | $202K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 506 | $132K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 294 | $88K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 631 | $66K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 735 | — |
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.