| 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 | $39K | — | $39K | 2.58% |
| FORSITE BENEFIT PARTNERS3 Filed as: FORSITE BENEFITS | 2300 RIVERSIDE DR. STE 204 GREEN BAY, WI 54301 | DELTA DENTAL OF WISCONSIN | $12K | — | $12K | 9.88% |
| 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 | 10.33% |
| 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 | 11.76% |
| FORSITE BENEFIT PARTNERS3 Filed as: FORSITE BENEFIT PARTNERS LLC | 2300 RIVERSIDE DR. GREEN BAY, WI 54301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $5K | 11.10% |
| FORSITE BENEFIT PARTNERS3 Filed as: FORSITE BENEFIT PARTNERS LLC | 2300 RIVERSIDE DR. GREEN BAY, WI 54301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $941 | $6K | 17.62% |
| FORSITE BENEFIT PARTNERS8 Filed as: FORSITE BENEFITS | 2300RIVERSIDE DR. STE 204 GREEN BAY, WI 54301 | WYSSTA INSURANCE COMPANY INC | $2K | — | $2K | 8.68% |
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 | 408 | 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) | 408 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREVEA360 HEALTH PLAN | 410 | $1.5M |
| Dental | DELTA DENTAL OF WISCONSIN | 203 | $118K |
| Vision | WYSSTA INSURANCE COMPANY INC | 165 | $19K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 412 | $76K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 174 | $57K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 413 | $51K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 412 | $76K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 413 | — |
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.