| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $1K | $1K | 1.68% |
| USI INSURANCE SERVICES LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $461 | $461 | 1.68% |
| USI INSURANCE SERVICES LLC | 319 E 3RD ST CHASKA, MN 55318 | PACIFIC GUARDIAN LIFE INSURANCE COMPANY LTD | $1K | — | $1K | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES INC EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | 9700 HEALTHCARE LANE MINNETONKA, MN 55343 | $135K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094741 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 2801 HOOVER ROAD PO BOX 828 STEVENS POINT, WI 54481 | $10K |
| UNUM LIFE INSURANCE CO OF AMERICA EIN 01-0278678 ADMIN SERVICE PROVIDER | Other services Service code 49 | 1 FOUNTAIN SQUARE CHATTANOOGA, TN 37402 | $3K |
| USI INSURANCE SERVICES LLC EIN 13-3771734 INSURANCE AGENT OR BROKER | Other commissions; Insurance agents and brokers Service code 22 | 711 EISENHOWER DR KIMBERLY, WI 54136 | $1K |
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 | 204 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 204 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 61 | $661K |
| Vision | SUPERIOR VISION PLAN | 97 | $14K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 44 | $27K |
| Short-term disability | PACIFIC GUARDIAN LIFE INSURANCE COMPANY LTD | 36 | $9K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 110 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 110 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.