| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LSG INSURANCE PARTNERS3 | 2600 S TELEGRAPH RD STE 100 BLOOMFIELD, MI 48302 | UNITED HEALTHCARE INSURANCE COMPANY | $37K | — | $37K | 3.68% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 400 N EXECUTIVE DR STE 300 BROOKFIELD, WI 53005 | UNITED HEALTHCARE INSURANCE COMPANY | $11K | $4K | $15K | 1.51% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WI INC | 400 N EXECUTIVE DR STE 300 BROOKFIELD, WI 53005 | SUN LIFE ASSURANCE COMPANY OF CANADA | $7K | — | $7K | 16.83% |
| JAY R SCHREIBMAN3 Filed as: JAY ROBERT SCHREIBMAN | 3518 ERIE DRIVE ORCHARD LAKE, MI 48324 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | $1K | — | $1K | 7.15% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN | 93033 NETWORK PLACE SUITE 300 CHICAGO, IL 60673 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | $272 | — | $272 | 1.89% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WI INC | 400 N EXECUTIVE DR STE 300 BROOKFIELD, WI 53005 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 16.12% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WI INC | 400 N EXECUTIVE DR STE 300 BROOKFIELD, WI 53005 | SUN LIFE ASSURANCE COMPANY OF CANADA | $316 | — | $316 | 17.39% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 TPA | Contract Administrator Service code 13 | — | $6K |
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 | 200 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 200 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 142 | $1.0M |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | 200 | $14K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 174 | $11K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 0 | $2K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 172 | $44K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 200 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.