| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MELISSA ANN WERNER3 Filed as: MELISSA WERNER | 2500 E ENTERPRISE DR STE D APPLETON, WI 54913 | WPS HEALTH PLAN INC | $17K | — | $17K | 2.14% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 2120 PEWAUKEE RD WAUKESHA, WI 53188 | DELTA DENTAL OF WISCONSIN | $4K | — | $4K | 8.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 2120 PEWAUKEE RD STE 202 WAUKESHA, WI 53188 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $179 | $4K | 15.75% |
| STELLARUS BENEFITS INC3 | 2500 E. ENTERPRISE AVE SUITE D APPLETON, WI 54913 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $252 | — | $252 | 4.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 2158 RIVERSIDE, CA 92506 | UNITEDHEALTHCARE INSURANCE COMPANY | $392 | — | $392 | 11.14% |
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 | 109 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | WPS HEALTH PLAN INC | 158 | $815K |
| Dental | DELTA DENTAL OF WISCONSIN | 54 | $52K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | 34 | $5K |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 104 | $4K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 68 | $24K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 68 | $24K |
| Other | UNITEDHEALTHCARE INSURANCE COMPANY | 104 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 158 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.