| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSOCIATED FINANCIAL GROUP LLC3 | 711 EISENHOWER DR KIMBERLY, WI 54136 | STANDARD INSURANCE COMPANY | $9K | — | $9K | 10.42% |
| NATIONAL BENEFIT CENTER3 Filed as: NATIONAL BENEFIT CENTER LLC | 6830 COCHRAN ROAD SOLON, OH 44139 | STANDARD INSURANCE COMPANY | $781 | — | $781 | 0.96% |
| JEFFREY A GENTZ3 | 8918 29TH CT KENOSHA, WI 53143 | AFLAC | $6K | $1K | $7K | 13.84% |
| THE WICHMANN GROUP INC3 | 12207 S 210TH ST GRETNA, NE 68028 | AFLAC | $860 | $244 | $1K | 2.23% |
| KRISTINE A PEREZ3 | PO BOX 673 GENOA CITY, WI 53128 | AFLAC | $855 | $173 | $1K | 2.08% |
| JACK D BREES3 | 2725 S MOORLAND RD SUITE 301 NEW BERLIN, WI 53151 | AFLAC | $341 | $20 | $361 | 0.73% |
| JOSEPH P HOFFMAN3 | 601 N THORNBUSH CIR HARTLAND, WI 53029 | AFLAC | $276 | $20 | $296 | 0.60% |
| KARA SUE STADEL3 | 4049 N RAWLINS RD GALENA, IL 61036 | AFLAC | $215 | — | $215 | 0.43% |
| JARED J BUCK3 | 2725 S MOORLAND RD STE 301 NEW BERLIN, WI 53151 | AFLAC | $195 | — | $195 | 0.39% |
| PATRICIA MELL3 | 6718 FIELDSTONE DR BURR RIDGE, IL 60527 | AFLAC | $122 | $18 | $140 | 0.28% |
| HOLLY A MARITA3 | 4623 HARDING RD KENOSHA, WI 53142 | AFLAC | $80 | — | $80 | 0.16% |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | AFLAC | $70 | — | $70 | 0.14% |
| GARY L GAULE3 | 415 S HARVEY AVE APT 2S OAK PARK, IL 60302 | AFLAC | $53 | $10 | $63 | 0.13% |
| CASEY J HIGGINS3 | 3083 LYMANS RUN SUN PRAIRIE, WI 53590 | AFLAC | $43 | — | $43 | 0.09% |
| KENNETH J HOFFMAN3 | N59W24060 CLOVER DR APT 131 SUSSEX, WI 53089 | AFLAC | $31 | — | $31 | 0.06% |
| JOHN H VRATSINAS3 | 2821 N OCEAN BLVD APT 305 FORT LAUDERDALE, FL 33308 | AFLAC | $28 | — | $28 | 0.06% |
| CHARLES H HENRI3 | 20105 DOLPHIN AVE LYNWOOD, IL 60411 | AFLAC | $19 | — | $19 | 0.04% |
| PATRICIA M LEACH3 | 4405 HONEYWOOD LN JACKSON, WI 53037 | AFLAC | $13 | — | $13 | 0.03% |
| HENRI INSURANCE SERVICES INC3 | 20105 DOLPHIN AVE LYNWOOD, IL 60411 | AFLAC | $9 | $2 | $11 | 0.02% |
| JV FLORIDA INSURANCE CORP3 | 2821 N OCEAN BLVD APT 305 FT LAUDERDALE, FL 33308 | AFLAC | $6 | — | $6 | 0.01% |
| SHADEL & ASSOCIATES LLC3 Filed as: SHADEL & ASSOCIATES INC | 126 HOPKINS ST NEPTUNE BEACH, FL 32266 | AFLAC | $6 | — | $6 | 0.01% |
| JEREMY KOOI3 | 270 SHAKERAG ST MINERAL POINT, WI 53565 | AFLAC | $6 | — | $6 | 0.01% |
| CHRISTOPHER J ZELLNER3 Filed as: CHRISTOPHER ZELLNER | 918 ALDORA LN WAUNAKEE, WI 53597 | AFLAC | $6 | — | $6 | 0.01% |
| ADAM THOMAS GARDNER3 | 101 N FARWELL ST STE 203 EAU CLAIRE, WI 54703 | AFLAC | $6 | — | $6 | 0.01% |
| ASSOCIATED FINANCIAL GROUP LLC3 | 711 EISENHOWER DR KIMBERLY, WI 541362142 | UNITED HEALTHCARE INSURANCE COMPANY | $2K | $166 | $2K | 13.06% |
| UMR, INC.5 Filed as: UNITED HEALTHCARE BENEFIT SERVICES | 10701 WEST RESEARCH DRIVE WAUWATOSA, WI 53226 | UNITED HEALTHCARE BENEFIT SERVICES | — | $4K | $4K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARMACY BENEFIT MANAGEME | Direct payment from the plan; Claims processing; Other fees; Float revenue Service code 12 | 3100 AMS BLVD GREEN BAY, WI 543139700 | $370K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | 3100 AMS BLVD GREEN BAY, WI 543139700 | $51K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 1233 NORTH MAYFAIR ROAD SUITE 204 MILWAUKEE, WI 53226 | $10K |
| ASSOCIATED BENEFITS & RISK CONSULTI BROKER | Insurance agents and brokers Service code 22 | 711 EISENHOWER DR KIMBERLY, WI 54136 | $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 | 244 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 244 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 209 | $19K |
| Life insurance | STANDARD INSURANCE COMPANY | 244 | $82K |
| Short-term disability | STANDARD INSURANCE COMPANY | 244 | $82K |
| Long-term disability | STANDARD INSURANCE COMPANY | 244 | $82K |
| Other(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 193 | $512K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 244 | — |
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.