| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNS INSURANCE AGENCY LLC3 | 500 S CENTRAL AVENUE MARHSFIELD, WI 54449 | SECURITY HELATH PLAN OF WISCONSIN, INC. | $10K | $0 | $10K | 1.75% |
| BURNS INSURANCE AGENCY LLC3 | 500 S CENTRAL AVENUE MARSHFIELD, WI 54449 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | — |
| BRENDA LEE CANNING3 | 4227 THRU STREET ST CLOUD, MN 56303 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $337 | $2K | — |
| RENELLE THERESA ROESLER3 | 220 QUINCY ST ONALASKA, WI 54650 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $348 | $2K | — |
| LAWRENCE RAY TERRY3 | W4988 MC LAREN RD LACROSSE, WI 54601 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $6 | $2K | — |
| BLUE SKY BENEFIT SOLUTIONS INC3 Filed as: BLUE SKY BENEFIT SOLUTIONS INC. | 1500 39TH ST SOUTH ST CLOUD, MN 56301 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $273 | $1K | — |
| TRACY LEE BAILEY3 | 29717 131ST STREET PRINCETON, MN 55371 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $114 | $74 | $188 | — |
| INSURANCE SERVICE CENTER INC3 | P.O. BOX 787 MARSHFIELD, WI 54449 | COMPANION LIFE INSURANCE COMPANY | $2K | $0 | $2K | — |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP | 5110 N 40TH STREET STE 234 PHOENIX, AZ 85018 | COMPANION LIFE INSURANCE COMPANY | $1K | $0 | $1K | — |
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 | 126 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SECURITY HELATH PLAN OF WISCONSIN, INC. | 71 | $564K |
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 125 | $0 |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 118 | $0 |
| Prescription drug | SECURITY HELATH PLAN OF WISCONSIN, INC. | 71 | $564K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 125 | — |
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.