| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R & R INSURANCE SERVICES INC3 | N14W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $4K | 24.27% |
| R & R INSURANCE SERVICES INC3 | N14 W23900 STONE RIDGE DR WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $1K | $3K | 19.36% |
| R & R INSURANCE SERVICES INC3 | N14W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $1K | $2K | 18.73% |
| R & R INSURANCE SERVICES INC3 | N14 W23900 STONE RIDGE DR WAUKESHA, WI 53188 | WYSSTA INSURANCE COMPANY INC | $721 | — | $721 | 7.92% |
| R & R INSURANCE SERVICES INC3 | P.O. BOC 1610 WAUKESHA, WI 53187 | CARE-PLUS DENTAL PLANS, INC | $103 | — | $103 | 7.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| R & R INSURANCE SERVICES INC AGENT OR BROKER | Insurance agents and brokers Service code 22 | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | $12K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | — | $5K |
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 | 250 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 250 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CARE-PLUS DENTAL PLANS, INC | 7 | $1K |
| Vision | WYSSTA INSURANCE COMPANY INC | 69 | $9K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 190 | $28K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 28 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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.