| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 500 W MONROE SREET, SUITE 3400 CHICAGO, IL 60661 | UNITEDHEALTHCARE INSURANCE COMPANY | $30K | — | $30K | 1.97% |
| LOCKTON COMPANIES, LLC3 | 15939 COLLECTIONS CTR DR CHICAGO, IL 60693 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $17K | — | $17K | 4.58% |
| LOCKTON COMPANIES, LLC3 | 15939 COLLECTIONS CTR DR CHICAGO, IL 60693 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | — | $8K | 4.58% |
| LOCKTON COMPANIES, LLC3 | 525 W MONROE STREET, SUITE 600 CHICAGO, IL 60661 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $8K | — | $8K | 5.37% |
| LOCKTON COMPANIES, LLC3 | 15939 COLLECTIONS CTR DR. CHICAGO, IL 60693 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 4.57% |
| LOCKTON COMPANIES, LLC3 | 525 W MONROE STREET, SUITE 600 CHICAGO, IL 60661 | FOUR EVER LIFE INS CO. | $3K | — | $3K | 15.00% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $231 | $1K | 9.97% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 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 | 25.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES INC EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $941K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 ADMINISTRATOR | Contract Administrator Service code 13 | — | $77K |
| LOCKTON COMPANIES LLC EIN 20-3354970 BROKER | Other commissions Service code 55 | 500 W MONROE ST, STE 3400 CHICAGO, IL 606613778 | $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 | 1,904 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 29 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,935 | 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 INC. | 2,347 | $158K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,827 | $371K |
| Short-term disability | FEDERAL INSURANCE COMPANY | 778 | $6K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,901 | $175K |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 3,522 | $1.5M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,222 | $66K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,522 | — |
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."
No prospect flags tripped on this filing.