| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MELISSA WIDUCKI3 | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $3K | $67 | $3K | 6.36% |
| RICKY E ROBINSON3 Filed as: RICKY ROBINSON | 934 SWEENEY DR STE ONE HAGERSTOWN, MD 21740 | AFLAC | $752 | $46 | $798 | 1.76% |
| CHEYANNA BRANDER3 | 2206 PARK RD WAUSAU, WI 54401 | AFLAC | $747 | — | $747 | 1.65% |
| ALISON M MORROW3 Filed as: ALISON MORROW | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $710 | $32 | $742 | 1.64% |
| LYNN KARL3 | W10030 PARKSIDE LN ANTIGO, WI 54409 | AFLAC | $417 | $12 | $429 | 0.95% |
| LISA M LOUDIN3 Filed as: LISA LOUDIN | 2129 GUILFORD RD ROCKFORD, IL 61107 | AFLAC | $392 | $10 | $402 | 0.89% |
| DAVID R PONTA3 Filed as: DAVID PONTA | 145 S DUKE ST STE B YORK, PA 17401 | AFLAC | $301 | — | $301 | 0.66% |
| RAMON PURVIS3 | 380 VALLEY DR FAYETTEVILLE, PA 17222 | AFLAC | $263 | $33 | $296 | 0.65% |
| KRISTIN ARVIGO3 | 2781 W MUD CREEK RD MOUNT MORRIS, IL 61504 | AFLAC | $210 | — | $210 | 0.46% |
| TRICIA SCHOENECK3 | 3462 COLUMBUS LAKE RD EAGLE RIVER, WI 54521 | AFLAC | $172 | $25 | $197 | 0.43% |
| DAVID W BRANDT3 Filed as: DAVID BRANDT | 46 WINDSOR WAY RED LION, PA 17356 | AFLAC | $175 | — | $175 | 0.39% |
| MICHAEL J SKOFF3 Filed as: MICHAEL SKOFF | 317 MARKET ST ROCKFORD, IL 61107 | AFLAC | $168 | $2 | $170 | 0.38% |
| BETH LUANNE KIMBROUGH3 Filed as: BETH KIMBROUGH | 6750 N ANDREWS AVE STE 200 FT LAUDERDALE, FL 33309 | AFLAC | $158 | — | $158 | 0.35% |
| JAMEY MILLER INC3 | 4811 BEACH BLVD STE 107 JACKSONVILLE, FL 32207 | AFLAC | $121 | — | $121 | 0.27% |
| TRICIA BLAIR3 | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $108 | — | $108 | 0.24% |
| ROBERT J DONOHUE3 Filed as: ROBERT DONOHUE | 808 FAIRWAY DRIVE MOSINEE, WI 54455 | AFLAC | $103 | — | $103 | 0.23% |
| BRANDT INC3 | 3111 EXPRESSO WAY YORK, PA 17406 | AFLAC | $88 | — | $88 | 0.19% |
| MARK JOHNSTON3 | 934 SWEENEY DR STE 8 HAGERSTOWN, MD 21740 | AFLAC | $74 | — | $74 | 0.16% |
| MICHAEL E MCCARTHY3 Filed as: MICHAEL MCCARTHY | PO BOX 1047 DUNDEE, IL 60118 | AFLAC | $72 | $2 | $74 | 0.16% |
| ARON D TERAN3 Filed as: ARON TERAN | 3684 HOLBORN PL FREDERICK, MD 21704 | AFLAC | $61 | $13 | $74 | 0.16% |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | AFLAC | $58 | — | $58 | 0.13% |
| GLEN T SCHWEIKERT3 Filed as: GLEN SCHWEIKERT | 2211 HIGHLAND SPRINGS PL LOUISVILLE, KY 40245 | AFLAC | $46 | — | $46 | 0.10% |
| PATRICK KREFT3 | 107 EDDY RD EDGAR, WI 54426 | AFLAC | $38 | — | $38 | 0.08% |
| STEVEN T SPEICHINGER3 Filed as: STEVEN SPEICHINGER | 210 KENT ST WAUSAU, WI 54403 | AFLAC | $36 | — | $36 | 0.08% |
| DONA DONOHUE3 | 808 FIARWAY DRIVE MOSINEE, WI 54455 | AFLAC | $33 | — | $33 | 0.07% |
| DENNIS J CASSENS3 Filed as: DENNIS CASSENS | 4646 E MARRILL RD STE 1 BYRON, IL 61010 | AFLAC | $25 | — | $25 | 0.06% |
| RICKY PINGEL3 | E8645 SWAMP RD CLINTONVILLE, WI 54929 | AFLAC | $24 | — | $24 | 0.05% |
| MICHAEL C WALKER3 Filed as: MICHAEL WALKER | 203 MARKET ST STE 201 HARVRE DE GRACE, MD 21078 | AFLAC | $24 | — | $24 | 0.05% |
| KIMBERLY L LUSHBAUGH3 Filed as: KIMBERLY LUSHBAUGH | 14 CATAWBA CIRCLE HAGERSTOWN, MD 21742 | AFLAC | $22 | — | $22 | 0.05% |
| MARK D BARBIER3 Filed as: MARK BARBIER | 602 DEER TRAIL LN OAK BROOK, IL 60523 | AFLAC | $15 | — | $15 | 0.03% |
| LEAH FINUCAN3 | 716 FULTON ST APT 7 WAUSAU, WI 54403 | AFLAC | $10 | $5 | $15 | 0.03% |
| SAMANTHA MICHAELSON3 Filed as: SAMANTHA BREUER | 101 N FARWELL ST STE 203 EAU CLAIRE, WI 54703 | AFLAC | $11 | — | $11 | 0.02% |
| MANDY RUECHEL3 | 1030 LUM AVE WATERLOO, WI 53594 | AFLAC | $9 | — | $9 | 0.02% |
| JEREMY KOOI3 Filed as: JEREMY KOOL | 3495 HUNTER HOLLOW RD DODGEVILLE, WI 53533 | AFLAC | $4 | $2 | $6 | 0.01% |
| PENNY NUNES3 | PO BOX 7135 APPLETON, WI 54912 | AFLAC | $4 | — | $4 | 0.01% |
| ADAM WICHMANN3 | 4362 N BULL RUSH DR APPLETON, WI 54913 | AFLAC | $4 | — | $4 | 0.01% |
| RYAN R KRUEGER3 Filed as: RYAN KRUEGER | 2293 MYSTIC MEADOW DR KRONENWETTER, WI 54455 | AFLAC | $4 | — | $4 | 0.01% |
| TIMOTHY ASBY3 | 11500 GOLDEN WILLOW CT ZIONSVILLE, IN 46077 | AFLAC | $4 | — | $4 | 0.01% |
| CHRISTOPHER J ZELLNER3 Filed as: CHRISTOPHER ZELLNER | 918 ALDORA LN WAUNAKEE, WI 53597 | AFLAC | $2 | $2 | $4 | 0.01% |
| JEFFREY D HARNED3 Filed as: JEFFREY MUSSOLINO | 805 HAMILTON BLVD HAGERSTOWN, MD 21742 | AFLAC | $3 | — | $3 | 0.01% |
| WILLIAM F MURRAY III3 Filed as: WILLIAM MURRAY III | 1298 SAINT PATRICK WAY SUN PRAIRIE, WI 53590 | AFLAC | $3 | — | $3 | 0.01% |
| ALAN SCHACMAN3 Filed as: ALAN SCHACHMANN | 5880 BONNIE LN MANITOWISH WATERS, WI 54545 | AFLAC | $2 | — | $2 | 0.00% |
| IRENE E BROOKS3 Filed as: IRENE BROOKS | 833 NORTH PARK ROAD SUITE 220 READING, PA 19610 | AFLAC | $2 | — | $2 | 0.00% |
| ROSS C NELSON3 Filed as: ROSS NELSON | 4611 S 96TH ST STE 100 OMAHA, NE 68127 | AFLAC | $2 | — | $2 | 0.00% |
| MICHAEL C WALKER3 Filed as: MICHAEL RISKA | 203 MARKET ST STE 201 HARVE DE GRACE, MD 21078 | AFLAC | $2 | — | $2 | 0.00% |
| SCOTT R SLAJUS3 Filed as: SCOTT LAUB | 1615 N 1ST AVE WAUSAU, WI 54401 | AFLAC | $2 | — | $2 | 0.00% |
| JASON D ELLIS3 Filed as: JASON ELLIS | 203 MARKET STREET STE 210 HAVRE DE GRACE, MD 21078 | AFLAC | $2 | — | $2 | 0.00% |
| FRANCES SHAFFER3 | 14025 TOWER RD SMITHSBURG, MD 21783 | AFLAC | $1 | — | $1 | 0.00% |
| RETTENMUND INSURANCE LLC3 | S7991 DENZER RD NORTH FREEDOM, WI 53951 | AFLAC | $1 | — | $1 | 0.00% |
| ADAM THOMAS GARDNER3 Filed as: ADAM GARDNER | 101 N FARWELL ST STE 203 EAU CLAIRE, WI 54703 | AFLAC | $1 | — | $1 | 0.00% |
| CHRISTINE LOGSLETT3 | 300 N CORPORATE DR STE 300 BROOKFIELD, WI 53045 | AFLAC | $1 | — | $1 | 0.00% |
| ELIZABETH A LENZO3 Filed as: ELIZABETH LENZO | 1840 VIA DEL REY SOUTH PASADENA, CA 91030 | AFLAC | $1 | — | $1 | 0.00% |
| SHADEL & ASSOCIATES LLC3 Filed as: SHADEL & ASSOCIATES INC | 4811 BEACH BLVD STE 107 JACKSONVILLE, FL 32207 | AFLAC | $0 | — | $0 | 0.00% |
| NATHAN BRONSON3 | W217 N5386 TAYLORS WOODS DR MENOMONEE FALLS, WI 53051 | AFLAC | $0 | — | $0 | 0.00% |
| JEREMY A FELDMAN3 Filed as: JEREMY FELDMAN | 15324 SWEETBAY ST WOODBINE, MD 21797 | AFLAC | $0 | $0 | $0 | 0.00% |
| JOSEPH P CALARCO3 Filed as: JOSEPH NASCA | 280801 W MAPLE AVE BARRINGTON, IL 60010 | AFLAC | $0 | $0 | $0 | 0.00% |
| TODD DEVOSS3 | 321 N CLARK ST STE 325 CHICAGO, IL 60654 | AFLAC | $0 | $0 | $0 | 0.00% |
| BRIAN W PATTEN3 Filed as: BRIAN PATTEN | 120 MARGUERITE DR STE 101 CRANBERRY TOWNSHIP, PA 16066 | AFLAC | $0 | $0 | $0 | 0.00% |
| JACQUELINE CASTRO3 | 100 WALL ST. FL 28 NEW YORK, NY 10005 | AFLAC | $0 | $0 | $0 | 0.00% |
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INSURANCE SERVICES | 555 MAIN ST. STE 291 RACINE, WI 534031000 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | $2K | — | $2K | 11.75% |
| JOHNSON INSURANCE SERVICES LLC3 | 555 MAIN ST STE 291 RACINE, WI 53403 | PRINCIPAL LIFE INSURANCE COMPANY | $508 | $37 | $545 | 10.67% |
| ROGERS BENEFIT GROUP INC3 | 5110 N 40TH ST STE 234 PHOENIX, AZ 85018 | PRINCIPAL LIFE INSURANCE COMPANY | $204 | — | $204 | 4.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRAIRIE STATES CLAIMS PROCESSING | Claims processing Service code 12 | 401 NORTH MICHIGAN AVE STE 2902 CHICAGO, ID 60611 | $26K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $4K |
| JOHNSON INSURANCE SERVICES LLC INS AGENT OR BROKER | Insurance agents and brokers Service code 22 | 555 MAIN ST. STE 291 RACINE, WI 53403 | $2K |
| COFINITY EIN 20-1274723 CLAIMS PROCESSING | Other insurance fees and expenses; Claims processing Service code 12 | — | $0 |
| FH GROUP CORP EIN 20-1736437 CLAIMS PROCESSING | Other insurance fees and expenses; Claims processing Service code 12 | — | $0 |
| GLOBALCARE EIN 31-1407689 CLAIMS PROCESSING | Other insurance fees and expenses; Claims processing Service code 12 | — | $0 |
| MAGELLAN EIN 46-3708039 OTHER INS FEES | Other insurance fees and expenses Service code 73 | — | $0 |
| PHCS/MULTIPLAN EIN 39-1634080 CLAIMS PROCESSING | Claims processing; Other insurance fees and expenses Service code 12 | — | $0 |
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 | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AFLAC | 73 | $45K |
| Vision(2 contracts, 2 carriers) | AFLAC | 86 | $59K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 108 | $5K |
| Stop-loss / reinsurancereinsurance | STANDARD SECURITY LIFE INS CO OF NEW YORK | 156 | $205K |
| Other(2 contracts, 2 carriers) | STANDARD SECURITY LIFE INS CO OF NEW YORK | 156 | $251K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 156 | — |
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.