| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FORSITE BENEFIT PARTNERS3 Filed as: FORSITE BENEFIT PARTNERS LLC | TIMOTHY MUELLER 2300 RIVERSIDE DR. GREEN BAY, WI 54301 | PREVEA360 HEALTH PLAN | $24K | — | $24K | 2.32% |
| FORSITE BENEFIT PARTNERS3 Filed as: FORSITE BENEFIT PARTNERS, LLC. | 2300 RIVERSIDE DR. GREEN BAY, WI 54301 | PREVEA360 HEALTH PLAN | $6K | — | $6K | 1.34% |
| FORSITE BENEFIT PARTNERS3 Filed as: FORSITE BENEFITS | 2300 RIVERSIDE DR. STE 204 GREEN BAY, WI 54301 | DELTA DENTAL OF WISCONSIN | $10K | — | $10K | 9.58% |
| FORSITE BENEFIT PARTNERS3 Filed as: FORSITE BENEFIT PARTNERS LLC | 2300 RIVERSIDE DR. GREEN BAY, WI 54301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 12.32% |
| FORSITE BENEFIT PARTNERS3 Filed as: FORSITE BENEFIT PARTNERS LLC | 2300 RIVERSIDE DR. GREEN BAY, WI 54301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 13.99% |
| FORSITE BENEFIT PARTNERS3 Filed as: FORSITE BENEFIT PARTNERS LLC | 2300 RIVERSIDE DR. GREEN BAY, WI 54301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 13.41% |
| FORSITE BENEFIT PARTNERS3 Filed as: FORSITE BENEFIT PARTNERS LLC | 2300 RIVERSIDE DR. GREEN BAY, WI 54301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $1K | $6K | 19.17% |
| FORSITE BENEFIT PARTNERS3 Filed as: FORSITE BENEFITS | 2300 RIVERSIDE DR. STE 204 GREEN BAY, WI 54301 | WYSSTA INSURANCE COMPANY INC | $1K | — | $1K | 7.92% |
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 | 283 | 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) | 283 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | PREVEA360 HEALTH PLAN | 377 | $1.5M |
| Dental | DELTA DENTAL OF WISCONSIN | 174 | $105K |
| Vision | WYSSTA INSURANCE COMPANY INC | 145 | $18K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 290 | $70K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 143 | $51K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 291 | $46K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 290 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 377 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.