| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY | 2725 SOUTH MOORLAND RD NEW BERLIN, WI 531510925 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 5.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY | PO BOX 510925 NEW BERLIN, WI 53151 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 5.66% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY | PO BOX 510925 NEW BERLIN, WI 531510925 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $10K | — | $10K | 20.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY | PO BOX 510925 NEW BERLIN, WI 531510925 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $797 | — | $797 | 5.90% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY | 2725 SOUTH MOORLAND DR NEW BERLIN, WI 53151 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN | $1K | — | $1K | 9.96% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY | PO BOX 510925 NEW BERLIN, WI 531510925 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $694 | — | $694 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CYPRESS BENEFIT ADMINISTRATORS LLC EIN 39-1997579 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 5560 W GRANDE MARKET DRIVE APPLETON, WI 54913 | $37K |
| MARSH & MCLENNAN AGENCY EIN 36-1436000 INSURANCE AGENT | Insurance agents and brokers Service code 22 | 2725 SOUTH MOORLAND RD NEW BERLIN, WI 53151 | $17K |
| AMERICAN HEALTH HOLDING EIN 31-1368946 OTHER | Other insurance fees and expenses Service code 73 | PO BOX 6016 WORTHINGTON, OH 43085 | $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 | 114 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ASG RISK MANAGEMENT | 114 | $286K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 247 | $69K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN | 136 | $12K |
| Life insurance(3 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 161 | $79K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 150 | $108K |
| Prescription drug | ASG RISK MANAGEMENT | 114 | $286K |
| Stop-loss / reinsurancereinsurance | ASG RISK MANAGEMENT | 114 | $286K |
| Other(3 contracts, 3 carriers) | ASG RISK MANAGEMENT | 161 | $358K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 247 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.