| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE | 1103 HUNTER DR RACINE, WI 53406 | PREVEA360 HEALTH PLAN | $48K | $0 | $48K | 2.49% |
| JOHNSON INSURANCE SERVICES LLC3 | 1103 HUNTER DR, STE 100 MOUNT PLEASANT, WI 53406 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | $0 | $11K | 9.12% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE | 1103 HUNTER DR, STE 100 MOUNT PLEASANT, WI 53406 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $0 | $3K | 2.10% |
| JOHNSON INSURANCE SERVICES LLC3 | 1103 HUNTER DR MOUNT PLEASANT, WI 53406 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 6.25% |
| CAMERON SUTTON ROBERTS3 | N9404 ROSELLA DRIVE APPLETON, WI 54915 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $465 | $4K | 5.59% |
| MIH BENEFITS LLC3 | 106 CUMBERLYNN DR FOND DU LAC, WI 54935 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $263 | $2K | 3.03% |
| DANIEL FROST3 | 241 POYGAN RD OMRO, WI 54963 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $228 | $2K | 3.00% |
| RODNEY JAMES SONNENBERG3 | 432 AMORY ST FOND DU LAC, WI 54935 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $531 | $0 | $531 | 0.77% |
| ADAM J ZAHN3 | 725 E GRANT STREET APPLETON, WI 54911 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $323 | $57 | $380 | 0.55% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WI EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | 2801 HOOVER RD STEVENS POINT, WI 54481 | $7K |
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 | 171 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREVEA360 HEALTH PLAN | 309 | $1.9M |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 341 | $194K |
| Short-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 341 | $194K |
| Long-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 341 | $194K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 341 | $125K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 341 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.