| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | PO BOX 51187 NEW BERLIN, WI 53151 | DELTA DENTAL OF WISCONSIN | $8K | — | $8K | 4.81% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES, LLC | 16805 WEST CLEVELAND AVENUE NEW BERLIN, WI 53151 | NATIONAL VISION ADMINISTRATORS, LLC | $3K | — | $3K | 10.00% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH DBA WORKSITE BENEFIT | SERVICES INC 246 INVERNESS CENTER DR BIRMINGHAM, AL 35242 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $740 | — | $740 | 6.90% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA HNI RISK SERVICES | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $333 | — | $333 | 3.11% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH DBA WORKSITE BENEFIT | SERVICES INC 246 INVERNESS CENTER DR BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $263 | — | $263 | 3.38% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA HNI RISK SERVICES | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $123 | — | $123 | 1.58% |
| EIDSON, DARELL, LAWAYNE3 | 246 INVERNESS CTR DR BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.14% |
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 | 399 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 407 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED BEHAVIORAL HEALTH DBA OPTUM | 100 | $4K |
| Dental | DELTA DENTAL OF WISCONSIN | 384 | $167K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 463 | $30K |
| Life insurance | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 21 | $8K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 37 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 463 | — |
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.