| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCHWARZ INSURANCE3 | 1420 NORTH RIDGE DRIVE PRAIRIE DU SAC, WI 53578 | AMERICAN FIDELITY | $32K | $0 | $32K | 11.88% |
| SCHWARZ INSURANCE3 | 1420 NORTH RIDGE DRIVE PRAIRIE DU SAC, WI 53578 | DELTA DENTAL OF WISCONSIN | $5K | $0 | $5K | 5.82% |
| SCHWARZ INSURANCE3 | 1420 NORTH RIDGE DR PRAIRIE DU SAC, WI 53578 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | $0 | $5K | 15.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN | PO BOX 9201 AUSTIN, TX 78766 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $2K | $2K | 5.01% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $2K | $2K | 5.00% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $554 | $554 | 1.71% |
| SCHWARZ INSURANCE3 | 1420 NORTH RIDGE DR PRAIRIE DU SAC, WI 53578 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 15.01% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN | PO BOX 9201 AUSTIN, TX 78766 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $1K | $1K | 5.00% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $1K | $1K | 5.00% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $455 | $455 | 1.61% |
| SCHWARZ INSURANCE3 | 1420 NORTH RIDGE DRIVE PRAIRIE DU SAC, WI 535780040 | DEARBORN NATIONAL LIFE INSURANCE CO | $489 | $0 | $489 | 11.25% |
| GIS BENEFITS INC3 Filed as: GIS OF ILLINOIS | 422 WAUPONSEE STREET MORRIS, IL 60450 | DEARBORN NATIONAL LIFE INSURANCE CO | $193 | $0 | $193 | 4.44% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN | PO BOX 9201 AUSTIN, TX 78766 | DEARBORN NATIONAL LIFE INSURANCE CO | $163 | $0 | $163 | 3.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLIANCE BENEFIT GROUP MEDICAL SERV EIN 42-1489487 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | 2450 RIMROCK RD, STE 301 MADISON, WI 54713 | $76K |
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 | 125 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AMERICAN FIDELITY | 125 | $272K |
| Dental | DELTA DENTAL OF WISCONSIN | 99 | $87K |
| Life insurance(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 166 | $33K |
| Prescription drug | AMERICAN FIDELITY | 125 | $272K |
| Stop-loss / reinsurancereinsurance | AMERICAN FIDELITY | 125 | $272K |
| Other(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 166 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 166 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.