| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | PO BOX 51187 NEW BERLIN, WI 53151 | DELTA DENTAL OF WISCONSIN | $9K | — | $9K | 4.24% |
| ACRISURE LLC3 Filed as: ACRISURE LLC DBA | HNI RISK SERVICES 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | NATIONAL VISION ADMINISTRATORS, LLC | $4K | — | $4K | 10.00% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH DBA WORKSITE BENEFIT | SERVICES INC 246 INVERNESS CENTER DR, STE 100 BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $183 | — | $183 | 3.34% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA HNI RISK SERVICES | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $85 | — | $85 | 1.55% |
| EIDSON, DARELL, LAWAYNE3 | 246 INVERNESS CTR DR BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.11% |
| 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 | $49 | — | $49 | 6.87% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA HNI RISK SERVICES | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $22 | — | $22 | 3.09% |
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 | 475 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 484 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 450 | $217K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 604 | $38K |
| Life insurance | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 15 | $5K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 30 | $713 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 604 | — |
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.