| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD CHICAGO, IL 60604 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $12K | — | $12K | 1.27% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE, SUITE 400 VALHALLA, NY 10595 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $7K | — | $7K | 0.69% |
| USI INSURANCE SERVICES LLC3 | MOUNT CENTRAL PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $12K | $22K | 13.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 15162 COLLECTION CENTER DR CHICAGO, IL 60603 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 4.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSOKN BLVD CHICAGO, IL 606040000 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 9.67% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC-WI | 711 EISENHOWER DR KIMBERLY, WI 54136 | WYSSTA INSURANCE COMPANY INC | $1K | — | $1K | 7.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON CHICAGO, IL 60604 | DELTA DENTAL OF WISCONSIN | $429 | — | $429 | 9.59% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | WYSSTA INSURANCE COMPANY, INC. | $63 | — | $63 | 8.05% |
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 | 116 | 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) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | DELTA DENTAL OF WISCONSIN | 74 | $53K |
| Vision(2 contracts) | WYSSTA INSURANCE COMPANY INC | 72 | $14K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $157K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $157K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $157K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 142 | $965K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $157K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 142 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.