| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SPG/CAPITOL SPECIAL RISKS3 | 1000 PARKWOOD CIRCLE ATLANTA, GA 30339 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $15K | — | $15K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT PLAN ADMINISTRATION OF WI, EIN 39-1400101 NONE | Claims processing; Plan Administrator; Direct payment from the plan; Other services Service code 12 | — | $1.1M |
| UNITED HEALTHCARE INSURANCE COMPANY EIN 36-2739571 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $812K |
| ELIXIR RX EIN 90-1011712 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $155K |
| CASE MANAGEMENT SPECIALISTS, INC. EIN 61-1688248 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $124K |
| REINHART BOERNER VAN DEUREN S.C. EIN 39-1126909 NONE | Legal; Direct payment from the plan Service code 29 | — | $119K |
| ASSOCIATED TRUST COMPANY, N.A. EIN 39-6576073 NONE | Direct payment from the plan; Investment management; Other services; Investment management fees paid directly by plan Service code 28 | — | $68K |
| LEE JOST & ASSOCIATES EIN 39-1400101 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $56K |
| ASCENSION MEDICAL GROUP NONE | Claims processing; Direct payment from the plan Service code 12 | 5412 HWY 10 E STEVENS POINT, WI 54482 | $38K |
| SIKICH LLP EIN 36-3168081 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $23K |
| AURORA EMPLOYEE ASSISTANCE PROGRAM NONE | Direct payment from the plan; Claims processing Service code 12 | 4067 N. 92ND STREET MILWAUKEE, WI 53222 | $22K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $22K |
| ANDCO CONSULTING LLC EIN 59-3676225 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $15K |
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 | 1,708 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 391 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,099 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. | 506 | $1.7M |
| Dental | CARE PLUS DENTAL PLANS, INC. | 125 | $110K |
| Life insurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 2,031 | $98K |
| Long-term disability | FIDELITY SECURITY LIFE INSURANCE COMPANY | 2,031 | $98K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 1,792 | $764K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,031 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.