| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 3390 UNIVERSITY AVE, SUITE 300 RIVERSIDE, CA 92501 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $14K | $5K | $19K | 14.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INT'L MIDWEST LIMITED | ATTN ACCOUNTING 55 E JACKSON BLVD STE 14B CHICAGO, IL 60604 | TOKIO MARINE | $3K | — | $3K | 10.00% |
| ALISON HINTON DAVIS3 Filed as: ALISON SPEICHINGER | — | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $589 | — | $589 | 3.00% |
| JOSEPH P CALARCO3 Filed as: JOSEPH R JURGENSMIER | — | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $471 | — | $471 | 2.40% |
| MICHAEL C WALKER3 Filed as: MICHAEL DAVID HELLER | — | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $107 | — | $107 | 0.54% |
| RONALD E. KRUEGER3 Filed as: RONALD E KRUEGER | — | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $80 | — | $80 | 0.41% |
| ELIZABETH MARIE LANGEVIN3 Filed as: ELIZABETH PROBST | — | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $59 | — | $59 | 0.30% |
| JOSHUA PAUL GROUP INC3 Filed as: JOSHUA C WRIGHT | — | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $57 | — | $57 | 0.29% |
| GARY WAYNE WARE3 | — | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $16 | — | $16 | 0.08% |
| KIMBERLY FERGUSON3 Filed as: KIMBERLY ROSE MARQUARDT | — | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $12 | — | $12 | 0.06% |
| ADVANTAGE GROUP MGS, LLC3 | 510 ALDERSON ST SCHOFIELD, WI 54476 | TRANSAMERICA LIFE INSURANCE COMPANY | $484 | — | $484 | 4.64% |
| GARY WOOD ASSOCIATES, INC.3 Filed as: GARY WARE AND ASSOCIATES INC | 3808 W. SPRINGFIELD AVE SUITE C CHAMPAIGN, IL 61822 | TRANSAMERICA LIFE INSURANCE COMPANY | $191 | — | $191 | 1.83% |
| JOSEPH P CALARCO3 Filed as: JOSEPH R JURGENSMIER | 130 ETHEL ST WAUSAU, WI 544037024 | TRANSAMERICA LIFE INSURANCE COMPANY | $100 | — | $100 | 0.96% |
| MICHAEL D. HELLER3 Filed as: MICHAEL D HELLER | 97 SOUTH STREET LITTLETON, NH 03561 | TRANSAMERICA LIFE INSURANCE COMPANY | $43 | — | $43 | 0.41% |
| US BANCORP INSURANCE SERVICES LLC3 | 7TH WASHINGTON 22ND FLOOR ST LOUIS, MO 63101 | TRANSAMERICA LIFE INSURANCE COMPANY | $43 | — | $43 | 0.41% |
| RONALD KRUEGER SR3 | 685 NORTH AVE ANTIGO, WI 54409 | TRANSAMERICA LIFE INSURANCE COMPANY | $37 | — | $37 | 0.35% |
| ELIZABETH MARIE LANGEVIN3 Filed as: ELIZABETH PROBST | N10759 HWY 151 MALONE, WI 53049 | TRANSAMERICA LIFE INSURANCE COMPANY | $4 | — | $4 | 0.04% |
| SMS ENTERPRISES INC3 | 16 LAMPSHIRE DRIVE RENO, NV 89506 | TRANSAMERICA LIFE INSURANCE COMPANY | $4 | — | $4 | 0.04% |
| MARQUARDT INSURANCE GROUP INC3 Filed as: MARQUARDT INSURANCEGROUP INC | 510 ALDERSON ST SCHOFIELD, WI 54476 | TRANSAMERICA LIFE INSURANCE COMPANY | $3 | — | $3 | 0.03% |
| BARBARA A SCHIEDERMAYER3 | N 159 BRUX RD APPLETON, WI 54915 | TRANSAMERICA LIFE INSURANCE COMPANY | $3 | — | $3 | 0.03% |
| LARRY GORDON AGENCYINC3 | 111 EAST WACKER DR, STE 310 CHICAGO, IL 60601 | TRANSAMERICA LIFE INSURANCE COMPANY | $3 | — | $3 | 0.03% |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $126K |
| Life insurance(2 contracts, 2 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $137K |
| Short-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $126K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $126K |
| Other(4 contracts, 4 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $183K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 130 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.