| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RICHARD HUDOCK3 | STE 2300 100 E WISCONSIN AVE MILWAUKEE, WI 53202 | NORTHWESTERN MUTUAL | $33K | $8K | $41K | 12.90% |
| THE HOLTER AGENCY INC3 | STE 2300 100 E WISCONSIN AVE MILWAUKEE, WI 53202 | NORTHWESTERN MUTUAL | $7K | $636 | $8K | 2.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 39-0138065 NONE | Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing Service code 12 | — | $1.1M |
| INNOVATIVE SOFTWARE SOLUTIONS, INC EIN 23-2182079 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $178K |
| REINHART BOERNER VAN DEUREN EIN 39-1126909 NONE | Legal Service code 29 | — | $177K |
| CAREWISE HEALTH INC EIN 95-3999237 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $74K |
| COMBINED CRAFTS EIN 39-1400101 NONE | Accounting (including auditing) Service code 10 | — | $48K |
| UNITED ACTUARIAL SERVICES, INC EIN 35-2156428 NONE | Actuarial Service code 11 | — | $45K |
| WHN INVESTORS EIN 39-1382973 NONE | Investment advisory (plan) Service code 27 | — | $28K |
| BAUMAN ASSOCIATES, LTD EIN 39-1277627 NONE | Accounting (including auditing) Service code 10 | — | $27K |
| FAIR HEALTH, INC EIN 90-0524293 NONE | Claims processing Service code 12 | — | $19K |
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 | 2,941 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 453 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 108 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,502 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | STANDARD INSURANCE COMPANY | 3,376 | $168K |
| Long-term disability | NORTHWESTERN MUTUAL | 3,502 | $316K |
| Prescription drug | UNITED HEALTHCARE INSURANCE COMPANY | 814 | $766K |
| Stop-loss / reinsurancereinsurance | ULLICO | 3,042 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,502 | — |
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.