| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INSURANCE | 555 MAIN ST STE #320 RACINE, WI 53402 | UNITY HEALTH PLANS INSURANCE CORPORATION | $25K | — | $25K | 2.18% |
| JOHNSON INSURANCE SERVICES LLC3 | 555 MAIN ST STE 291 RACINE, WI 53403 | DELTA DENTAL OF WISCONSIN | $7K | — | $7K | 4.87% |
| JOHNSON INSURANCE SERVICES LLC3 | 525 JUNCTION ROAD MADISON, WI 53717 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $2K | $11K | 8.60% |
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INSURANCE SERVICES | 555 MAIN ST STE 291 RACINE, WI 53403 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $1K | — | $1K | 9.03% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $8K |
| JOHNSON INSURANCE SERVICES LLC INSURANCE AGENTS/BROKERS | Insurance agents and brokers Service code 22 | 555 MAIN ST. STE 291 RACINE, WA 53403 | $370 |
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 | 174 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 163 | $135K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 168 | $14K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 321 | $133K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 321 | $133K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 321 | $133K |
| Prescription drug | UNITY HEALTH PLANS INSURANCE CORPORATION | 330 | $1.1M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 321 | $133K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 330 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.