| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MELISSA WIDUCKI3 | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $8K | $226 | $8K | 14.08% |
| RICKY E ROBINSON3 Filed as: RICKY ROBINSON | 934 SWEENEY DR STE ONE HAGERSTOWN, MD 21740 | AFLAC | $1K | $24 | $1K | 2.48% |
| ALISON M MORROW3 Filed as: ALISON MORROW | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $1K | $44 | $1K | 1.94% |
| LYNN KARL3 | W10030 PARKSIDE LN ANTIGO, WI 54409 | AFLAC | $647 | $10 | $657 | 1.15% |
| LISA M LOUDIN3 Filed as: LISA LOUDIN | 2129 GUILFORD RD ROCKFORD, IL 61107 | AFLAC | $449 | — | $449 | 0.78% |
| DAVID R PONTA3 Filed as: DAVID PONTA | 145 S DUKE ST STE B YORK, PA 17401 | AFLAC | $299 | — | $299 | 0.52% |
| CHELSIE CLEEREMAN3 | 1776 FOREST AVE WABENO, WI 54566 | AFLAC | $198 | — | $198 | 0.35% |
| DAVID W BRANDT3 Filed as: DAVID BRANDT | 46 WINDSOR WAY RED LION, PA 17356 | AFLAC | $174 | — | $174 | 0.30% |
| BETH LUANNE KIMBROUGH3 Filed as: BETH KIMBROUGH | 6750 N ANDREWS AVE STE 200 FT LAUDERDALE, FL 33309 | AFLAC | $145 | — | $145 | 0.25% |
| TRICIA BLAIR3 | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $133 | $11 | $144 | 0.25% |
| BRYAN FISH3 | 4050 CANDLE LIGHT DR DAYTON, MD 21036 | AFLAC | $121 | — | $121 | 0.21% |
| MICHAEL J SKOFF3 Filed as: MICHAEL SKOFF | 815 N CHURCH ST ROCKFORD, IL 61103 | AFLAC | $81 | — | $81 | 0.14% |
| PETER J TEKAMPE3 | 815 N CHURCH ST ROCKFORD, IL 61103 | AFLAC | $81 | — | $81 | 0.14% |
| ROBERT J DONOHUE3 Filed as: ROBERT DONOHUE | 808 FAIRWAY DRIVE MOSINEE, WI 54455 | AFLAC | $75 | — | $75 | 0.13% |
| BRANDT INC3 | 3111 EXPRESSO WAY YORK, PA 17406 | AFLAC | $57 | — | $57 | 0.10% |
| MARK JOHNSTON3 | 124 UNDERKE TER HEDGESVILLE, WV 25427 | AFLAC | $50 | — | $50 | 0.09% |
| ELENA F FRYCZYNSKI3 | 1115 MICHIGAN AVE GLADSTONE, MI 49837 | AFLAC | $48 | — | $48 | 0.08% |
| RAMON PURVIS3 | 380 VALLEY DR FAYETTEVILLE, PA 17222 | AFLAC | $46 | — | $46 | 0.08% |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | AFLAC | $45 | — | $45 | 0.08% |
| JAMEY MILLER INC3 | 10375 CENTURION PRKWY N STE 100 JACKSONVILLE, FL 32256 | AFLAC | $44 | — | $44 | 0.08% |
| TRICIA SCHOENECK3 | 3462 COLUMBUS LAKE RD EAGLE RIVER, WI 54521 | AFLAC | $40 | — | $40 | 0.07% |
| GLEN T SCHWEIKERT3 Filed as: GLEN SCHWEIKERT | 2211 HIGHLAND SPRINGS PL LOUISVILLE, KY 40245 | AFLAC | $38 | — | $38 | 0.07% |
| PATRICK KREFT3 | 107 EDDY RD EDGAR, WI 54426 | AFLAC | $29 | — | $29 | 0.05% |
| KIMBERLY L LUSHBAUGH3 Filed as: KIMBERLY LUSHBAUGH | 14 CATAWBA CIRCLE HAGERSTOWN, MD 21742 | AFLAC | $28 | — | $28 | 0.05% |
| SAMANTHA J LEITERITZ3 | 1137 RALEIGH ST GREEN BAY, WI 54304 | AFLAC | $23 | — | $23 | 0.04% |
| STEVEN T SPEICHINGER3 Filed as: STEVEN SPEICHINGER | 3008 CHRISTIAN AVE WAUSAU, WI 54401 | AFLAC | $20 | — | $20 | 0.03% |
| MICHAEL C WALKER3 Filed as: MICHAEL WALKER | 203 MARKET ST STE 201 HARVRE DE GRACE, MD 21078 | AFLAC | $18 | — | $18 | 0.03% |
| MARSH & MCLENNAN AGENCY LLC3 | PO BOX 510925 NEW BERLIN, WI 53151 | AFLAC | $18 | — | $18 | 0.03% |
| MARK JOHNSTON3 Filed as: MARK A JOHNSTON | 934 SWEENEY DR STE 8 HAGERSTOWN, MD 21740 | AFLAC | $13 | $4 | $17 | 0.03% |
| ARON D TERAN3 Filed as: ARON TERAN | 3812 CARRIAGE HILL DR FREDERICK, MD 21704 | AFLAC | $16 | — | $16 | 0.03% |
| MARK D BARBIER3 Filed as: MARK BARBIER | 23 CROYDON LN OAK BROOK, IL 60523 | AFLAC | $15 | — | $15 | 0.03% |
| BRANDT INC3 | 360 LOUCKS RD STE 305 YORK, PA 17404 | AFLAC | $15 | — | $15 | 0.03% |
| BRANDT INC3 | 3111 EXPRESSO WAY YORK, PA 17406 | AFLAC | $15 | — | $15 | 0.03% |
| JEREMY KOOI3 | 3495 HUNTER HOLLOW RD DODGEVILLE, WI 53533 | AFLAC | $14 | — | $14 | 0.02% |
| KHRYSTEN KAYE GOSS3 | 2550 OLD ALEX CT OSHKOSH, WA 54904 | AFLAC | $14 | — | $14 | 0.02% |
| DENNIS J CASSENS3 Filed as: DENNIS CASSENS | 4646 E MARRILL RD STE 1 BYRON, IL 61010 | AFLAC | $12 | — | $12 | 0.02% |
| SAMANTHA MICHAELSON3 Filed as: SAMANTHA BREUER | 101 N FARWELL ST STE 203 EAU CLAIRE, WI 54703 | AFLAC | $12 | — | $12 | 0.02% |
| BEJAMIN BAKER3 | 5351 BROADWAY ST NEWALD, WI 54511 | AFLAC | $12 | — | $12 | 0.02% |
| IRENE E BROOKS3 Filed as: IRENE BROOKS | 101 COPPER BEECH LN WOMELSDORF, PA 19567 | AFLAC | $10 | — | $10 | 0.02% |
| CHRISTOPHER WATSON3 | 1123 N 8TH AVE STURGEON BAY, WI 54235 | AFLAC | $10 | — | $10 | 0.02% |
| MICHAEL C WALKER3 Filed as: MICHAEL RISKA | 203 MARKET ST STE 201 HARVE DE GRACE, MD 21078 | AFLAC | $9 | — | $9 | 0.02% |
| WILLIAM F MURRAY III3 Filed as: WILLIAM MURRAY III | 1298 SAINT PATRICK WAY SUN PRAIRIE, WI 53590 | AFLAC | $8 | — | $8 | 0.01% |
| CHRISTOPHER J ZELLNER3 Filed as: CHRISTOPHER ZELLNER | 918 ALDORA LN WAUNAKEE, WI 53597 | AFLAC | $7 | — | $7 | 0.01% |
| MANDY RUECHEL3 | 1030 LUM AVE WATERLOO, WI 53594 | AFLAC | $7 | — | $7 | 0.01% |
| ADAM WICHMANN3 | 780 CAPILANO CT CASTLE ROCK, CO 80108 | AFLAC | $6 | — | $6 | 0.01% |
| ROSS C NELSON3 Filed as: ROSS NELSON | 440 REGENCY PARKWAY DR STE 234 OMAHA, NE 68114 | 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% |
| PAUL W DESPIRITO3 | 3051 PROGESS WAY STE 204 KAUKAUNA, WI 54130 | AFLAC | $6 | — | $6 | 0.01% |
| MARY E SCHATZ3 | 1102 TONTI RD MARQUETTE, MI 49855 | AFLAC | $6 | — | $6 | 0.01% |
| SHANNON A LADING3 | 738 W 4TH ST APPLETON, WI 54914 | AFLAC | $6 | — | $6 | 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% |
| 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 | $1 | — | $1 | 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 | $1 | — | $1 | 0.00% |
| MICHAEL E MCCARTHY3 Filed as: MICHAEL MCCARTHY | PO BOX 1047 DUNDEE, IL 60118 | AFLAC | $1 | — | $1 | 0.00% |
| ROSS C NELSON3 | 4611 S 96TH ST STE 100 OMAHA, NC 68127 | AFLAC | $1 | — | $1 | 0.00% |
| ELIZABETH A LENZO3 | 701 ALBEROSKY WAY BATAVIA, IL 60510 | AFLAC | $1 | — | $1 | 0.00% |
| SHADEL & ASSOCIATES LLC3 Filed as: SHADEL & ASSOCIATES INC | 126 HOPKINS ST NEPTUNE BEACH, FL 32266 | AFLAC | $1 | — | $1 | 0.00% |
| ELIZABETH A LENZO3 | 1840 VIA DEL REY SOUTH PASADENA, CA 91030 | AFLAC | $1 | — | $1 | 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. | $1K | — | $1K | 10.00% |
| JOHNSON INSURANCE SERVICES LLC3 | 555 MAIN ST STE 291 RACINE, WI 53403 | PRINCIPAL LIFE INSURANCE COMPANY | $736 | $124 | $860 | 10.82% |
| ROGERS BENEFIT GROUP INC3 | 5110 N 40TH ST STE 234 PHOENIX, AZ 85018 | PRINCIPAL LIFE INSURANCE COMPANY | $303 | — | $303 | 3.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRAIRIE STATES CLAIMS PROCESSING | Claims processing Service code 12 | 401 NORTH MICHIGAN AVE STE 2902 CHICAGO, ID 60611 | $34K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $5K |
| 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 | Claims processing; Other insurance fees and expenses Service code 12 | — | $0 |
| GLOBALCARE EIN 31-1407689 CLAIMS PROCESSING | Claims processing; Other insurance fees and expenses 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 | 157 | 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) | 157 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AFLAC | 94 | $57K |
| Vision(2 contracts, 2 carriers) | AFLAC | 140 | $71K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 157 | $8K |
| Stop-loss / reinsurancereinsurance | WESTPORT INSURANCE CORP | 110 | $265K |
| Other(2 contracts, 2 carriers) | WESTPORT INSURANCE CORP | 110 | $323K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 157 | — |
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."
No prospect flags tripped on this filing.