| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITS ADVISORS SERVICES3 Filed as: BENEFITS ADVISORS INSURANCE | 2123 13TH ST S LA CROSSE, WI 54650 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $60K | — | $60K | 0.74% |
| DEREK J DAHL3 Filed as: DEREK J. DAHL | W292N3360 SUMMERHILL RD PEWAUKEE, WI 53072 | STARMOUNT LIFE INSURANCE COMPANY | $41K | — | $41K | 6.81% |
| DEREK J DAHL3 | N16W23217 STONE RIDGE DR STE 120 WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 2.52% |
| DEREK J DAHL3 | N16W23217 STONE RIDGE DR SUITE 120 WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 2.84% |
| DEREK J DAHL3 | N16W23217 STONE RIDGE DRIVE SUITE 120 WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11K | — | $11K | 7.81% |
| DEREK J DAHL3 | N16W23217 STONE RIDGE DR STE 120 WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 0.84% |
| DEREK J DAHL3 | N16W23217 STONE RIDGE DR SUITE 120 WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 8.11% |
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 | 925 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 18 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 23 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 966 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 1,962 | $8.1M |
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 640 | $599K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 640 | $599K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 899 | $188K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 925 | $412K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 898 | $218K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 1,962 | $8.1M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 899 | $188K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,962 | — |
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.