| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 | 6952 ROTE RD ROCKFORD, IL 61112 | SUN LIFE INSURANCE COMPANY OF CANADA | $11K | $0 | $11K | 1.97% |
| WATCHTOWER TECHNOLOGIES INC3 Filed as: WATCHTOWER TECHNOLOGIES | 306 W ERIE ST SUITE 300 CHICAGO, IA 60654 | SUN LIFE INSURANCE COMPANY OF CANADA | $9K | $0 | $9K | 1.62% |
| M3 INSURANCE SOLUTIONS INC3 | 6952 ROTE RD ROCKFORD, IL 61112 | SUN LIFE ASSURANCE COMPANY OF CANADA | $25K | — | $25K | 20.85% |
| WATCHTOWER TECHNOLOGIES INC3 | 306 W ERIE ST. SUITE 300 CHICAGO, IL 60654 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 1.50% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DR. MADISON, WI 537131424 | VISION SERVICE PLAN | $2K | — | $2K | 3.20% |
| M3 INSURANCE SOLUTIONS INC3 | 6952 ROTE RD ROCKFORD, IL 61107 | AMERITAS LIFE INSURANCE CORP. | $4K | $0 | $4K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRAIRIE STATES ENTERPRISES EIN 36-3730559 NONE | Claims processing Service code 12 | 615 PENNSYLVANIA AVENUE SHEBOYGAN, WI 53081 | $693K |
| ST NICHOLAS HOSPITAL DBA PREVEA EIN 39-0808480 NONE | Claims processing Service code 12 | P.O. BOX 19070 GREEN BAY, WI 54307 | $636K |
| HEALTH PAYMENT SERVICES EIN 20-2702059 NONE | Claims processing Service code 12 | 1000 N WATER STREET SUITE 1100 MILWAUKEE, WI 53202 | $145K |
| SERVE YOU RX EIN 39-1735466 NONE | Claims processing Service code 12 | 10201 W INNOVATION DRIVE SUITE 600 MILWAUKEE, WI 53226 | $137K |
| GUARDIAN LIFE INSURANCE COMP EIN 06-1116976 NONE | Claims processing Service code 12 | P.O. BOX 677458 DALLAS, TX 75267 | $25K |
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 | 865 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 866 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP. | 118 | $36K |
| Vision | VISION SERVICE PLAN | 427 | $65K |
| Life insurance | SUN LIFE INSURANCE COMPANY OF CANADA | 1,068 | $577K |
| Long-term disability | SUN LIFE INSURANCE COMPANY OF CANADA | 1,068 | $577K |
| Stop-loss / reinsurancereinsurance | SUN LIFE INSURANCE COMPANY OF CANADA | 1,068 | $577K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 257 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,068 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.