| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 525 W MONROE ST, SUITE 600 CHICAGO, IL 60661 | UNITEDHEALTHCARE INSURANCE COMPANY | $123K | — | $123K | 10.02% |
| LOCKTON COMPANIES, LLC3 | 15939 COLLECTIONS CTR DR CHICAGO, IL 60693 | SUN LIFE ASSURANCE COMPANY OF CANADA | $18K | — | $18K | 5.00% |
| LOCKTON COMPANIES, LLC3 | 15939 COLLECTIONS CTR DR CHICAGO, IL 60693 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | — | $8K | 5.00% |
| LOCKTON COMPANIES, LLC3 | 525 W MONROE, SUITE 600 CHICAGO, IL 60661 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN | $5K | — | $5K | 5.00% |
| LOCKTON COMPANIES, LLC3 | 525 W MONROE CHICAGO, IL 60661 | FOUR EVER LIFE INS CO | $3K | — | $3K | 15.00% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $237 | $1K | 9.75% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOULTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.08% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFIT LLC | 1166 AVE OF AMERICAS 22F NEW YORK, NY 10036 | FEDERAL INSURANCE COMPANY | $1K | — | $1K | 20.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES INC EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $951K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 ADMINISTRATOR | Custodial (securities); Contract Administrator Service code 13 | — | $11K |
| LOCKTON COMPANIES LLC EIN 20-3354970 BROKER | Other commissions Service code 55 | 525 W MONROE ST, STE 600 CHICAGO, IL 606613640 | $0 |
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 | 626 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 657 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 532 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,815 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | FOUR EVER LIFE INS CO | 240 | $23K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN | 1,791 | $107K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,684 | $362K |
| Short-term disability | FEDERAL INSURANCE COMPANY | 75 | $6K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,684 | $167K |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 3,260 | $1.2M |
| Other | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 72 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,260 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.