| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | BLUE CROSS & BLUE SHIELD OF WISCONSIN | $15K | $2K | $17K | 1.59% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 54952 | BLUE CROSS & BLUE SHIELD OF WISCONSIN | $7K | $0 | $7K | 0.64% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | COMPCARE HEALTH SERVICES INSURANCE CORPORATION | $9K | $1K | $10K | 1.59% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 54592 | COMPCARE HEALTH SERVICES INSURANCE CORPORATION | $4K | $0 | $4K | 0.64% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVVE KIMBERLY, WI 54136 | RELIASTAR LIFE INSURANCE COMPANY | $8K | $0 | $8K | 6.48% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 225 MAINE ST MENASHA, WI 549520389 | RELIASTAR LIFE INSURANCE COMPANY | $7K | $0 | $7K | 5.89% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | N 16 W 23250 STONE RIDGE DR WAKESHA, WI 53188 | CARE-PLUS DENTAL PLANS, INC. | $641 | $0 | $641 | 6.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 711 EISENHOWER DR KIMBERLY, WI 54136 | WYSSTA INSURANCE COMPANY | $541 | $0 | $541 | 5.64% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE | PO BOX 389 MENASHA, WI 549520389 | WYSSTA INSURANCE COMPANY | $389 | $0 | $389 | 4.05% |
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 | 240 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 241 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS & BLUE SHIELD OF WISCONSIN | 155 | $1.7M |
| Dental | CARE-PLUS DENTAL PLANS, INC. | 43 | $11K |
| Vision | WYSSTA INSURANCE COMPANY | 124 | $10K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 305 | $127K |
| Long-term disability | RELIASTAR LIFE INSURANCE COMPANY | 305 | $127K |
| Other(2 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 305 | $133K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 305 | — |
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.