| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MELISSA WIDUCKI3 | 3648 COUNTY RD W CRANDON, WI 54520 | AFLAC | $7K | $15 | $7K | 9.64% |
| BEJAMIN BAKER3 | 5351 BROADWAY ST NEWALD, WI 54511 | AFLAC | $2K | — | $2K | 2.13% |
| ALICE MAGUIRE3 | 4512 TWIN PINES LN WESTON, WI 54476 | AFLAC | $2K | $3 | $2K | 2.06% |
| CORNELIUS B SAVOY3 | 1721 CHESAPEAKE LN APT 2 SCHAUMBURG, IL 60193 | AFLAC | $1K | — | $1K | 1.93% |
| KYLE G WHELTON3 | 133 N JACKSON ST APT 429 MILWAUKEE, WI 53202 | AFLAC | $1K | $3 | $1K | 1.63% |
| WHITLEY TOWNS WALDROP3 | 306 WINCHESTER DR POOLER, GA 31322 | AFLAC | $577 | — | $577 | 0.77% |
| RICKY E ROBINSON3 | 934 SWEENEY DR STE ONE HAGERSTOWN, MD 21740 | AFLAC | $514 | — | $514 | 0.69% |
| TAMMY ANN BACKHAUS3 | 179 MILL ST CAMPBELLSPORT, WI 53010 | AFLAC | $393 | — | $393 | 0.53% |
| DAVID R PONTA3 Filed as: DAVID PONTA | 145 S DUKE ST STE B YORK, PA 17401 | AFLAC | $322 | — | $322 | 0.43% |
| BRIAN S LOWE3 | 920 SARDIS DR BOAZ, AL 35956 | AFLAC | $270 | — | $270 | 0.36% |
| LISA M LOUDIN3 Filed as: LISA LOUDIN | 2129 GUILFORD RD ROCKFORD, IL 61107 | AFLAC | $192 | — | $192 | 0.26% |
| DAVID W BRANDT3 Filed as: DAVID BRANDT | 6908 FOX CHASE RD NEW MARKET, MD 21774 | AFLAC | $187 | — | $187 | 0.25% |
| MICHAEL E MCCARTHY3 | PO BOX 1047 DUNDEE, IL 60118 | AFLAC | $147 | — | $147 | 0.20% |
| ALISON M MORROW3 Filed as: ALISON MORROW | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $134 | — | $134 | 0.18% |
| BRIAN WHITE3 Filed as: BRIAN HANLEY | 1862 KEYSTONE PL SCHAUMBURG, IL 60193 | AFLAC | $128 | — | $128 | 0.17% |
| LYNN KARL3 | W10030 PARKSIDE LN ANTIGO, WI 54409 | AFLAC | $111 | — | $111 | 0.15% |
| RUBICON REGION LLC3 | 1862 KEYSTONE PL SCHAUMBURG, IL 60193 | AFLAC | $106 | — | $106 | 0.14% |
| JAMIE R LAUENSTEIN3 | 15 S WALNUT ST MAYVILLE, WI 53050 | AFLAC | $74 | — | $74 | 0.10% |
| MICHAEL FOWLER3 | 2204 EXECUTIVE PARK DR OPELIKA, AL 36801 | AFLAC | $71 | — | $71 | 0.10% |
| PAUL W DESPIRITO3 | 3051 PROGESS WAY STE 204 KAUKAUNA, WI 54130 | AFLAC | $67 | — | $67 | 0.09% |
| MICHAEL J SKOFF3 Filed as: MICHAEL SKOFF | 815 N CHURCH ST ROCKFORD, IL 61103 | AFLAC | $65 | — | $65 | 0.09% |
| BETH LUANNE KIMBROUGH3 Filed as: BETH KIMBROUGH | 6750 N ANDREWS AVE STE 200 FT LAUDERDALE, FL 33309 | AFLAC | $62 | — | $62 | 0.08% |
| BRYAN FISH3 | 4050 CANDLE LIGHT DR DAYTON, MD 21036 | AFLAC | $56 | — | $56 | 0.07% |
| JOHNSON INSURANCE SERVICES LLC3 | 318 S WASHINGTON ST STE 200 GREEN BAY, WI 53401 | AFLAC | $55 | — | $55 | 0.07% |
| BRANDT INC3 | 360 LOUCKS RD STE 305 YORK, PA 17404 | AFLAC | $54 | — | $54 | 0.07% |
| PETER J TEKAMPE3 | 6739 HARTWIG DR CHERRY VALLEY, IL 61016 | AFLAC | $54 | — | $54 | 0.07% |
| JEFFREY A. MUSSOLINO3 Filed as: JEFFREY A MUSSOLINO | 724 POTOMAC AVE HAGERSTOWN, MD 21740 | AFLAC | $54 | — | $54 | 0.07% |
| DEWAYNE D RAY3 | PO BOX 41 GUNTERSVILLE, AL 35976 | AFLAC | $49 | — | $49 | 0.07% |
| SALLY ANN WHITE3 | 3051 PROGRESS WAY STE 204 KAUKAUNA, WI 54130 | AFLAC | $41 | — | $41 | 0.05% |
| MICHELLE L THOMAS BRANDT3 | 1135 PLEASANT GROVE RD RED LION, PA 17356 | AFLAC | $39 | — | $39 | 0.05% |
| MARK JOHNSTON3 | 23 BELLADONNA DR HEDGESVILLE, WV 25427 | AFLAC | $33 | — | $33 | 0.04% |
| ROBERT J DONOHUE3 Filed as: ROBERT DONOHUE | 808 FAIRWAY DRIVE MOSINEE, WI 54455 | AFLAC | $32 | — | $32 | 0.04% |
| KELVIN MICHAEL RICE3 | 623 WESTBROOK RD DOTHAN, AL 36303 | AFLAC | $26 | — | $26 | 0.03% |
| TRICIA BLAIR3 | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $26 | — | $26 | 0.03% |
| SHANNON A LADING3 | 738 W 4TH ST APPLETON, WI 54914 | AFLAC | $23 | — | $23 | 0.03% |
| KRISTIN L ARVIGO3 | 917 WOODLANE AVE ROCKFORD, IL 61107 | AFLAC | $23 | — | $23 | 0.03% |
| JAMEY MILLER INC3 | 12942 193RD AVE E BONNEY LAKE, WA 98391 | AFLAC | $18 | — | $18 | 0.02% |
| GLEN T SCHWEIKERT3 Filed as: GLEN SCHWEIKERT | 2211 HIGHLAND SPRINGS PL LOUISVILLE, KY 40245 | AFLAC | $15 | — | $15 | 0.02% |
| DENNIS J CASSENS3 Filed as: DENNIS CASSENS | 4646 E MARRILL RD STE 1 BYRON, IL 61010 | AFLAC | $12 | — | $12 | 0.02% |
| SAMANTHA J BREUER3 | E4355 PINEWOOD CIR ELEVA, WI 54738 | AFLAC | $12 | — | $12 | 0.02% |
| IRENE E BROOKS3 Filed as: IRENE BROOKS | 101 COPPER BEECH LN WOMELSDORF, PA 19567 | AFLAC | $11 | — | $11 | 0.01% |
| KIMBERLY L LUSHBAUGH3 Filed as: KIMBERLY LUSHBAUGH | 14 CATAWBA CIRCLE HAGERSTOWN, MD 21742 | AFLAC | $11 | — | $11 | 0.01% |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | AFLAC | $10 | — | $10 | 0.01% |
| STEVEN T SPEICHINGER3 Filed as: STEVEN SPEICHINGER | 3008 CHRISTIAN AVE WAUSAU, WI 54401 | AFLAC | $10 | — | $10 | 0.01% |
| TRICIA SCHOENECK3 | 3462 COLUMBUS LAKE RD EAGLE RIVER, WI 54521 | AFLAC | $9 | — | $9 | 0.01% |
| MICHAEL C WALKER3 Filed as: MICHAEL WALKER | 203 MARKET ST STE 201 HARVRE DE GRACE, MD 21078 | AFLAC | $6 | — | $6 | 0.01% |
| JEREMY KOOI3 | 855 PANORAMA CT APT 203 RICHLAND CENTER, WI 53581 | AFLAC | $5 | — | $5 | 0.01% |
| MICHAEL C WALKER3 Filed as: MICHAEL RISKA | 203 MARKET ST STE 201 HARVE DE GRACE, MD 21078 | AFLAC | $5 | — | $5 | 0.01% |
| JASON D ELLIS3 Filed as: JASON ELLIS | 1 ELLIS CT STE 210 PERRYVILLE, MD 21903 | AFLAC | $5 | — | $5 | 0.01% |
| MARK D BARBIER3 Filed as: MARK BARBIER | 23 CROYDON LN OAK BROOK, IL 60523 | AFLAC | $4 | — | $4 | 0.01% |
| WILLIAM F MURRAY III3 Filed as: WILLIAM MURRAY III | 1298 SAINT PATRICK WAY SUN PRAIRIE, WI 53590 | AFLAC | $4 | — | $4 | 0.01% |
| ROSS C NELSON3 Filed as: ROSS NELSON | 440 REGENCY PARKWAY DR STE 234 OMAHA, NE 68114 | AFLAC | $3 | — | $3 | 0.00% |
| ARON D TERAN3 Filed as: ARON TERAN | 3812 CARRIAGE HILL DR FREDERICK, MD 21704 | AFLAC | $3 | — | $3 | 0.00% |
| CHRISTOPHER J ZELLNER3 Filed as: CHRISTOPHER ZELLNER | 918 ALDORA LN WAUNAKEE, WI 53597 | AFLAC | $2 | — | $2 | 0.00% |
| FRANCES SHAFFER3 | 14025 TOWER RD SMITHSBURG, MD 21783 | AFLAC | $2 | — | $2 | 0.00% |
| TIMOTHY ASBY3 | 11500 GOLDEN WILLOW CT ZIONSVILLE, IN 46077 | AFLAC | $2 | — | $2 | 0.00% |
| PATRICK KREFT3 | 107 EDDY RD EDGAR, WI 54426 | 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 | 3100 BLUFF LN HILLSBOROUGH, NC 27278 | 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 | 8318 ANNA AVE WIND LAKE, WI 53185 | AFLAC | $1 | — | $1 | 0.00% |
| JEREMY A FELDMAN3 Filed as: JEREMY FELDMAN | 12391 HIDDEN BAY DR BERLIN, MD 21811 | AFLAC | $1 | — | $1 | 0.00% |
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INSURANCE SERVICES | 318 SOUTH WASHINGTON STREET GREEN BAY, WI 54301 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | $928 | — | $928 | 5.09% |
| ASSUREDPARTNERS3 Filed as: DIMOND BROS INSURANCE LLC | PO BOX 1090 PARIS, IL 61944 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | $884 | — | $884 | 4.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $27K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $6K |
| DIMOND BROS INSURANCE LLC EIN 90-1017549 BROKER | Other commissions; Insurance agents and brokers Service code 22 | PO BOX 1090 PARIS, IL 61944 | $2K |
| JOHNSON INSURANCE SERVICES LLC EIN 56-2435265 BROKER | Other commissions Service code 55 | 1103 HUNTER DR, STE 100 MOUNT PLEASANT, WI 53406 | $450 |
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 | 215 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 20 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 235 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 176 | $10K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | 103 | $18K |
| Short-term disability | AFLAC | 94 | $75K |
| Other | AFLAC | 94 | $75K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 176 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.