| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MELISSA WIDUCKI3 | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $4K | $49 | $4K | 9.04% |
| RICKY E ROBINSON3 Filed as: RICKY ROBINSON | 934 SWEENEY DR STE ONE HAGERSTOWN, MD 21740 | AFLAC | $735 | — | $735 | 1.70% |
| ALISON M MORROW3 Filed as: ALISON MORROW | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $703 | $16 | $719 | 1.67% |
| DAVID R PONTA3 Filed as: DAVID PONTA | 145 S DUKE ST STE B YORK, PA 17401 | AFLAC | $299 | — | $299 | 0.69% |
| LYNN KARL3 | W10030 PARKSIDE LN ANTIGO, WI 54409 | AFLAC | $224 | $7 | $231 | 0.54% |
| LISA M LOUDIN3 Filed as: LISA LOUDIN | 2129 GUILFORD RD ROCKFORD, IL 61107 | AFLAC | $204 | $22 | $226 | 0.52% |
| TRICIA BLAIR3 | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $209 | — | $209 | 0.48% |
| DAVID W BRANDT3 Filed as: DAVID BRANDT | 46 WINDSOR WAY RED LION, PA 17356 | AFLAC | $174 | — | $174 | 0.40% |
| CHELSIE CLEEREMAN3 | 1776 FOREST AVE WABENO, WI 54566 | AFLAC | $153 | — | $153 | 0.35% |
| BETH LUANNE KIMBROUGH3 Filed as: BETH KIMBROUGH | 6750 N ANDREWS AVE STE 200 FT LAUDERDALE, FL 33309 | AFLAC | $146 | — | $146 | 0.34% |
| MICHAEL J SKOFF3 Filed as: MICHAEL SKOFF | 815 N CHURCH ST ROCKFORD, IL 61103 | AFLAC | $93 | $8 | $101 | 0.23% |
| MARK JOHNSTON3 | 124 UNDERKE TER HEDGESVILLE, WV 25427 | AFLAC | $94 | — | $94 | 0.22% |
| BRANDT INC3 | 3111 EXPRESSO WAY YORK, PA 17406 | AFLAC | $87 | — | $87 | 0.20% |
| ROBERT J DONOHUE3 Filed as: ROBERT DONOHUE | 808 FAIRWAY DRIVE MOSINEE, WI 54455 | AFLAC | $79 | — | $79 | 0.18% |
| KRISTIN ARVIGO3 | 2781 W MUD CREEK RD MOUNT MORRIS, IL 61504 | AFLAC | $50 | $20 | $70 | 0.16% |
| JAMEY MILLER INC3 | 4811 BEACH BLVD STE 107 JACKSONVILLE, FL 32207 | AFLAC | $57 | — | $57 | 0.13% |
| TRICIA SCHOENECK3 | 3462 COLUMBUS LAKE RD EAGLE RIVER, WI 54521 | AFLAC | $47 | $8 | $55 | 0.13% |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | AFLAC | $47 | — | $47 | 0.11% |
| RAMON PURVIS3 | 380 VALLEY DR FAYETTEVILLE, PA 17222 | AFLAC | $46 | — | $46 | 0.11% |
| GLEN T SCHWEIKERT3 Filed as: GLEN SCHWEIKERT | 2211 HIGHLAND SPRINGS PL LOUISVILLE, KY 40245 | AFLAC | $39 | — | $39 | 0.09% |
| MICHAEL E MCCARTHY3 Filed as: MICHAEL MCCARTHY | PO BOX 1047 DUNDEE, IL 60118 | AFLAC | $30 | $8 | $38 | 0.09% |
| PATRICK KREFT3 | 107 EDDY RD EDGAR, WI 54426 | AFLAC | $29 | — | $29 | 0.07% |
| STEVEN T SPEICHINGER3 Filed as: STEVEN SPEICHINGER | 210 KENT ST WAUSAU, WI 54403 | AFLAC | $27 | — | $27 | 0.06% |
| ARON D TERAN3 Filed as: ARON TERAN | 3684 HOLBORN PL FREDERICK, MD 21704 | AFLAC | $26 | — | $26 | 0.06% |
| KIMBERLY L LUSHBAUGH3 Filed as: KIMBERLY LUSHBAUGH | 14 CATAWBA CIRCLE HAGERSTOWN, MD 21742 | AFLAC | $22 | — | $22 | 0.05% |
| MICHAEL C WALKER3 Filed as: MICHAEL WALKER | 203 MARKET ST STE 201 HARVRE DE GRACE, MD 21078 | AFLAC | $19 | — | $19 | 0.04% |
| MARK D BARBIER3 Filed as: MARK BARBIER | 802 DEER TRAIL LN OAK BROOK, IL 60523 | AFLAC | $15 | — | $15 | 0.03% |
| JEREMY KOOI3 | 3495 HUNTER HOLLOW RD DODGEVILLE, WI 53533 | AFLAC | $15 | — | $15 | 0.03% |
| DENNIS J CASSENS3 Filed as: DENNIS CASSENS | 4646 E MARRILL RD STE 1 BYRON, IL 61010 | AFLAC | $12 | — | $12 | 0.03% |
| SAMANTHA MICHAELSON3 Filed as: SAMANTHA BREUER | 101 N FARWELL ST STE 203 EAU CLAIRE, WI 54703 | AFLAC | $11 | — | $11 | 0.03% |
| IRENE E BROOKS3 Filed as: IRENE BROOKS | 101 COPPER BEECH LN WOMELSDORF, PA 19567 | AFLAC | $10 | — | $10 | 0.02% |
| MANDY RUECHEL3 | 1030 LUM AVE WATERLOO, WI 53594 | AFLAC | $9 | — | $9 | 0.02% |
| WILLIAM F MURRAY III3 Filed as: WILLIAM MURRAY III | 1298 SAINT PATRICK WAY SUN PRAIRIE, WI 53590 | AFLAC | $9 | — | $9 | 0.02% |
| ROSS C NELSON3 Filed as: ROSS NELSON | 4611 S 96TH ST STE 100 OMAHA, NE 68127 | AFLAC | $9 | — | $9 | 0.02% |
| MICHAEL C WALKER3 Filed as: MICHAEL RISKA | 203 MARKET ST STE 201 HARVE DE GRACE, MD 21078 | AFLAC | $8 | — | $8 | 0.02% |
| DANIEL E ELLIS3 Filed as: DANIEL ELLIS | 377 E BUTTERFIELD RD STE 210 LOMBARD, IL 60148 | AFLAC | $8 | — | $8 | 0.02% |
| CHRISTOPHER J ZELLNER3 Filed as: CHRISTOPHER ZELLNER | 918 ALDORA LN WAUNAKEE, WI 53597 | AFLAC | $7 | — | $7 | 0.02% |
| DONA DONOHUE3 | 808 FAIRWAY DRIVE MOSINEE, WI 54455 | AFLAC | $6 | — | $6 | 0.01% |
| JASON D ELLIS3 Filed as: JASON ELLIS | 203 MARKET STREET STE 210 HAVRE DE GRACE, MD 21078 | AFLAC | $6 | — | $6 | 0.01% |
| ADAM WICHMANN3 | 780 CAPILANO CT CASTLE ROCK, CO 80108 | AFLAC | $4 | — | $4 | 0.01% |
| ADAM THOMAS GARDNER3 Filed as: ADAM GARDNER | 101 N FARWELL ST STE 203 EAU CLAIRE, WI 54703 | AFLAC | $4 | — | $4 | 0.01% |
| RYAN R KRUEGER3 Filed as: RYAN KRUEGER | 6234 TRANQUIL RIVER LN WAUSAU, WI 54401 | AFLAC | $3 | — | $3 | 0.01% |
| JEFFREY D HARNED3 Filed as: JEFFREY MUSSOLINO | 805 HAMILTON BLVD HAGERSTOWN, MD 21742 | AFLAC | $3 | — | $3 | 0.01% |
| TIMOTHY ASBY3 | 11500 GOLDEN WILLOW CT ZIONSVILLE, IN 46077 | AFLAC | $2 | — | $2 | 0.00% |
| FRANCES SHAFFER3 | 14025 TOWER RD SMITHSBURG, MD 21783 | AFLAC | $2 | — | $2 | 0.00% |
| CHRISTINE LOGSLETT3 | 300 N CORPORATE DR STE 300 BROOKFIELD, WI 53045 | AFLAC | $2 | — | $2 | 0.00% |
| SHADEL & ASSOCIATES LLC3 Filed as: SHADEL & ASSOCIATES INC | 4811 BEACH BLVD STE 107 JACKSONVILLE, FL 32207 | AFLAC | $2 | — | $2 | 0.00% |
| ELIZABETH A LENZO3 Filed as: ELIZABETH LENZO | 11177 JASMINE DR ROSCOE, IL 61073 | AFLAC | $1 | — | $1 | 0.00% |
| NATHAN BRONSON3 | W217 N5386 TAYLORS WOODS DR MENOMONEE FALLS, WI 53051 | AFLAC | $1 | — | $1 | 0.00% |
| JEREMY A FELDMAN3 Filed as: JEREMY FELDMAN | 15324 SWEETBAY ST WOODBINE, MD 21797 | AFLAC | $0 | — | $0 | 0.00% |
| JOSEPH P CALARCO3 Filed as: JOSEPH NASCA | 280801 W MAPLE AVE BARRINGTON, IL 60010 | AFLAC | $0 | — | $0 | 0.00% |
| TODD DEVOSS3 | 321 N CLARK ST STE 625 CHICAGO, IL 60654 | AFLAC | $0 | — | $0 | 0.00% |
| BRIAN W PATTEN3 Filed as: BRIAN PATTEN | 120 MARGUERITE DR STE 101 CRANBERRY TOWNSHIP, PA 16066 | AFLAC | $0 | — | $0 | 0.00% |
| JACQUELINE CASTRO3 | 100 WALL ST. FL 28 NEW YORK, NY 10005 | AFLAC | $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 | 9.99% |
| JOHNSON INSURANCE SERVICES LLC3 | 555 MAIN ST STE 291 RACINE, WI 53403 | PRINCIPAL LIFE INSURANCE COMPANY | $586 | — | $586 | 9.64% |
| ROGERS BENEFIT GROUP INC3 | 5110 N 40TH ST STE 234 PHOENIX, AZ 85018 | PRINCIPAL LIFE INSURANCE COMPANY | $238 | — | $238 | 3.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRAIRIE STATES CLAIMS PROCESSING | Claims processing Service code 12 | 401 NORTH MICHIGAN AVE STE 2902 CHICAGO, ID 60611 | $25K |
| 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 | Claims processing; Other insurance fees and expenses 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 | 131 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 138 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AFLAC | 82 | $43K |
| Vision(2 contracts, 2 carriers) | AFLAC | 113 | $59K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 131 | $6K |
| Stop-loss / reinsurancereinsurance | WESTPORT INSURANCE CORP | 98 | $209K |
| Other(2 contracts, 2 carriers) | WESTPORT INSURANCE CORP | 98 | $252K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 131 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.