| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 | 571 MONON BOULEVARD, SUITE 400 CARMEL, IN 46032 | GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN | $60K | $0 | $60K | 1.93% |
| MJ INSURANCE3 | 571 MONON BOULEVARD, SUITE 400 CARMEL, IN 46032 | DEAN HEALTH PLAN INC | $24K | $0 | $24K | 2.19% |
| MJ INSURANCE3 | 571 MONON BOULEVARD, SUITE 400 CARMEL, IN 46032 | DELTA DENTAL OF WISCONSIN | $25K | $0 | $25K | 8.02% |
| MJ INSURANCE3 | 571 MONON BOULEVARD, SUITE 400 CARMEL, IN 46032 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $34K | $3K | $37K | 16.45% |
| MJ INSURANCE3 | 571 MONON BOULEVARD, SUITE 400 CARMEL, IN 46032 | WYSSTA INSURANCE COMPANY INC | $3K | $0 | $3K | 8.04% |
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 | 405 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 407 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN | 527 | $4.2M |
| Dental | DELTA DENTAL OF WISCONSIN | 254 | $309K |
| Vision | WYSSTA INSURANCE COMPANY INC | 245 | $37K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 394 | $224K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 394 | $224K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 394 | $224K |
| Prescription drug(2 contracts, 2 carriers) | GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN | 527 | $4.2M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 394 | $224K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 527 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.