| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HNI RISK SERVICES3 Filed as: ACISURE, LLC DBA HNI RISK SERVICES | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | HCC LIFE INSURANCE COMPANY | $890 | — | $890 | 5.00% |
| ACRISURE LLC3 | PO BOX 51187 NEW BERLIN, WI 53151 | WYSSTA INSURANCE COMPANY INC | $1K | — | $1K | 8.00% |
| ACRISURE LLC3 Filed as: HNI RISK SERVICES LLC-ACRISURE LLC | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 11.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53708 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| ACRISURE LLC3 Filed as: HNI RISK SERVICES LLC-ACRISURE LLC | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 11.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53708 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| ACRISURE LLC3 Filed as: HNI RISK SERVICES LLC-ACRISURE LLC | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53251 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $729 | — | $729 | 10.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS | 828 JOHN NOLEN DRIVE MADISON, WI 53708 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| ACRISURE LLC3 Filed as: HNI RISK SERVICES LLC-ACRISURE LLC | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $302 | — | $302 | 11.01% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53708 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| ACRISURE LLC3 Filed as: HNI RISK SERVICES LLC-ACRISURE LLC | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $94 | — | $94 | 10.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53708 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
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 | 105 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC | 83 | $13K |
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 101 | $10K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 101 | $12K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 101 | $10K |
| Other(3 contracts, 2 carriers) | HCC LIFE INSURANCE COMPANY | 101 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 101 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.