| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | UNUM LIFE INSURANCE OF AMERICA | — | $2K | $2K | 3.28% |
| USI INSURANCE SERVICES LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | UNUM LIFE INSURANCE OF AMERICA | — | $106 | $106 | 0.35% |
| USI INSURANCE SERVICES LLC Filed as: USI LLC WI ABRC | PO BOX 62817 VIRGINIA BEACH, VA 23466 | SUPERIOR VISION PLAN/NATIONAL GUARDIAN INSURANCE COMPANY | — | — | $0 | 0.00% |
| USI INSURANCE SERVICES LLC | PO BOX 62817 VIRGINIA BEACH, VA 23466 | SUPERIOR VISION PLAN/NATIONAL GUARDIAN INSURANCE COMPANY | — | — | $0 | 0.00% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES LLC - SAVOIE | 319 E 3RD ST CHASKA, MN 55318 | PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. | $2K | — | $2K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | 9700 HEALTHCARE LANE MINNETONKA, MN 55343 | $141K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRS PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 2801 HOOVER ROAD PO BOX 828 STEVENS POINT, WI 54481 | $10K |
| UNUM LIFE INSURANCE COMPANY OF AMER EIN 01-0278678 ADMIN FOR STD SELF INSUR | Other services Service code 49 | 1 FOUNTAIN SQUARE CHATTANOOGA, TN 37402 | $4K |
| USI INSURANCE SERVICES LLC EIN 13-3771734 INSURANCE AGENT/BROKER | Other commissions; Insurance agents and brokers Service code 22 | 711 EISENHOWER DRIVE 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 | 185 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 185 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 37 | $570K |
| Vision | SUPERIOR VISION PLAN/NATIONAL GUARDIAN INSURANCE COMPANY | 105 | $15K |
| Life insurance | UNUM LIFE INSURANCE OF AMERICA | 41 | $31K |
| Short-term disability | PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. | 32 | $12K |
| Other | UNUM LIFE INSURANCE OF AMERICA | 99 | $67K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 105 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.