| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSOCIATED FINANCIAL GROUP LLC3 | 6000 CLEARWATER DRIVE MINNETONKA, MN 55343 | ANTHEM LIFE INSURANCE COMPANY | $9K | — | $9K | 5.64% |
| ASSOCIATED FINANCIAL GROUP LLC3 | 12600 WHITEWATER DR MINNETONKA, MN 55343 | ANTHEM LIFE INSURANCE COMPANY | $3K | — | $3K | 1.97% |
| ASSOCIATED FINANCIAL GROUP LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $21K | — | $21K | 14.91% |
| SCOTT, JAY N3 Filed as: SCOTT JAY N | 722 EISENHOWER DRIVE KIMBERLY, WI 54136 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $2K | — | $2K | 10.00% |
| ASSOCIATED FINANCIAL GROUP LLC3 | PO BOX 640 GREEN BAY, WI 543050640 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 15.00% |
| ASSOCIATED FINANCIAL GROUP LLC3 | 6000 CLEARWATER DR MINNETONKA, MN 55343 | HARTFORD LIFE AND ACCIDENT | $0 | $274 | $274 | 2.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $167K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATO | Contract Administrator Service code 13 | — | $13K |
| ASSOCIATED FINANCIAL GROUP, LLC BROKER | Insurance agents and brokers Service code 22 | JAY N. SCOTT 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | $448 |
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 | 320 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 29 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 21 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 370 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | 476 | $23K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 326 | $151K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 326 | $151K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 285 | $750K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 322 | $155K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 476 | — |
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.