| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSOCIATED FINANCIAL GROUP LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | ANTHEM BLUE CROSS ADN BLUE SHIELD | $0 | — | $0 | 0.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - WI | 711 EISENHOWER DRIVE KIMBERLY, WI 541360000 | DELTA DENTAL OF WISCONSIN | $6K | $13K | $19K | 17.90% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - MOUNT | PO BOX 6217 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $3K | $7K | 18.34% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - MOUNT | PO BOX 6217 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 17.20% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - MOUNT | PO BOX 6217 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $4K | 16.95% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - MOUNT | PO BOX 6217 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $4K | 17.69% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - MOUNT | PO BOX 6217 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $910 | $2K | 18.33% |
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 | 215 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS ADN BLUE SHIELD | 220 | $1.8M |
| Dental | DELTA DENTAL OF WISCONSIN | 144 | $106K |
| Vision | ANTHEM BLUE CROSS ADN BLUE SHIELD | 220 | $1.8M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $49K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 66 | $37K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 82 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 220 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.