| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| E.T. INC OF WISCONSIN3 Filed as: ET INC OF WISCONSIN DBA WALLACE | COOPER ELLIOT INSURANCE 197 S MAIN ST RICHLAND CENTER, WI 53581 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $26K | — | $26K | 1.07% |
| VANDERMUS, ROGER3 | 2941 WILD ROSE LANE ONALASKA, WI 54650 | USABLE LIFE | $19K | $2K | $21K | 16.61% |
| BENEUSA LLC3 | 261 SCHOOL AVE STE 350 EXCELSIOR, MN 55331 | USABLE LIFE | $6K | — | $6K | 5.00% |
| E.T. INC OF WISCONSIN3 Filed as: E.T. INC OF WISCONSIN DBA WALLACE, | COOPER AND ELLIOT 197 S. MAIN ST. P.O. BOX 470 RICHLAND CENTER, WI 53581 | NATIONAL VISION ADMINISTRATORS, L.L.C. | $2K | — | $2K | 10.00% |
| JOHN D TYLER3 Filed as: JOHN B TRIPOLI | 501 E MCBEE AVE GREENVILLE, SC 29601 | NORTHWESTERN MUTUAL | $729 | $193 | $922 | 9.49% |
| BRETT GEORGE SMITH3 | 501 E MCBEE AVE GREENVILLE, SC 29601 | NORTHWESTERN MUTUAL | $729 | $182 | $911 | 9.37% |
| RICHARD WORRELL LLC3 | 6235 MORRISON BLVD CHARLOTTE, NC 28211 | NORTHWESTERN MUTUAL | $219 | $26 | $245 | 2.52% |
| RICHARD WORRELL LLC3 | 6235 MORRISON BLVD CHARLOTTE, NC 28211 | NORTHWESTERN MUTUAL | $73 | $26 | $99 | 1.02% |
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 | 393 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 399 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 158 | $119K |
| Vision | NATIONAL VISION ADMINISTRATORS, L.L.C. | 221 | $23K |
| Life insurance | USABLE LIFE | 229 | $127K |
| Short-term disability | USABLE LIFE | 229 | $127K |
| Long-term disability | NORTHWESTERN MUTUAL | 252 | $10K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 393 | $2.4M |
| Other | USABLE LIFE | 229 | $127K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 393 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.