| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHNSON INSURANCE SERVICES LLC3 | 1103 HUNTER DRIVE STE 100 MOUNT PLEASANT, WI 53406 | BLUE CROSS & BLUE SHIELD OF WISCONSIN | $9K | $0 | $9K | 1.36% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INS BROKERAGE INC | 160 FEDERAL STREET BOSTON, MA 01982 | BLUE CROSS & BLUE SHIELD OF WISCONSIN | $9K | $0 | $9K | 1.30% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 54952 | BLUE CROSS & BLUE SHIELD OF WISCONSIN | $8K | $0 | $8K | 1.21% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INS BROKERAGE INC. | 160 FEDERAL STREET BOSTON, MA 01982 | STANDARD INSURANCE COMPANY | $3K | $217 | $3K | 6.16% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | PO BOX 389 MENASHA, WI 54952 | STANDARD INSURANCE COMPANY | $3K | $0 | $3K | 5.83% |
| JOHNSON INSURANCE SERVICES LLC3 | 1103 HUNTER DRIVE STE 100 MOUNT PLEASANT, WI 53406 | STANDARD INSURANCE COMPANY | $648 | $0 | $648 | 1.41% |
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 | 112 | 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) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS & BLUE SHIELD OF WISCONSIN | 100 | $681K |
| Dental | BLUE CROSS & BLUE SHIELD OF WISCONSIN | 100 | $681K |
| Vision | BLUE CROSS & BLUE SHIELD OF WISCONSIN | 100 | $681K |
| Life insurance | STANDARD INSURANCE COMPANY | 105 | $46K |
| Short-term disability | STANDARD INSURANCE COMPANY | 105 | $46K |
| Long-term disability | STANDARD INSURANCE COMPANY | 105 | $46K |
| Other | BLUE CROSS & BLUE SHIELD OF WISCONSIN | 100 | $681K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 105 | — |
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.