| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITS ADVISORS SERVICES3 Filed as: BENEFITS ADVISORS INSURANCE | 2123 13TH ST S LA CROSSE, WI 54601 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $63K | — | $63K | 0.75% |
| DEREK J DAHL3 Filed as: DEREK J. DAHL | W292N3360 SUMMERHILL RD PEWAUKEE, WI 53072 | STARMOUNT LIFE INSURANCE COMPANY | $42K | — | $42K | 6.83% |
| DEREK J DAHL3 | N16W23217 STONE RIDGE DR STE 120 WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 1.40% |
| ALICIA C DAHL3 | W292N3360 SUMMERHILL RD PEWAUKEE, WI 53072 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 0.98% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $333 | — | $333 | 0.13% |
| ALICIA C DAHL3 | W292N3360 SUMMERHILL RD PEWAUKEE, WI 53072 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 2.48% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $517 | — | $517 | 0.24% |
| DEREK J DAHL3 | N16W23217 STONE RIDGE DR STE 120 WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $344 | — | $344 | 0.16% |
| DEREK J DAHL3 | N16W23217 STONE RIDGE DR SUITE 120 WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 2.66% |
| ALICIA C DAHL3 | W292N3360 SUMMERHILL RD PEWAUKEE, WI 53072 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $579 | — | $579 | 0.28% |
| ALICIA C DAHL3 | W292N3360 SUMMERHILL RD PEWAUKEE, WI 53072 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 5.19% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 1.62% |
| DEREK J DAHL3 | N16W23217 STONE RIDGE DR STE 120 WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 1.00% |
| DEREK J DAHL3 | N16W23217 STONE RIDGE DRIVE SUITE 120 WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | — | $9K | 6.78% |
| ALICIA C DAHL3 | W292N3360 SUMMERHILL RD PEWAUKEE, WI 53072 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 1.07% |
| DEREK J DAHL3 | N16W23217 STONE RIDGE DR SUITE 120 WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 6.94% |
| ALICIA C DAHL3 | W292N3360 SUMMERHILL RD PEWAUKEE, WI 53072 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $610 | — | $610 | 1.33% |
| ALICIA C DAHL3 | W292N3360 SUMMERHILL RD PEWAUKEE, WI 53072 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 4.47% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 2.38% |
| DEREK J DAHL3 | N16W23217 STONE RIDGE DR STE 120 WAUKESHA, WI 53188 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $588 | — | $588 | 1.33% |
| STUART W EVERSON4 | S8131 PRAIRIE RD BIROQUA, WI 54665 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $3K | — | $3K | 18.13% |
| WILLIAM J WALKER4 | 3215 WAYLAND RD WAYLAND, IA 52654 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $377 | — | $377 | 2.16% |
| BRADLEY L WALKER4 | 1216 N 3RD AVE WASHINGTON, IA 52353 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $227 | — | $227 | 1.30% |
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 | 936 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 19 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 971 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 1,881 | $8.4M |
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 662 | $617K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 662 | $617K |
| Life insurance(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 865 | $369K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 864 | $261K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 865 | $418K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 1,881 | $8.4M |
| Other(5 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 865 | $386K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,881 | — |
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."
No prospect flags tripped on this filing.