| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRICOR, INC3 Filed as: TRICOR, INC. | 230 W CHERRY STREET LANCASTER, WI 53813 | HARTFORD LIFE AND ACCIDENT | $25K | — | $25K | 21.72% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WISCONSIN PHYSICIANS SERVICE EIN 39-1502106 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $303K |
| NORTHERN CAPITAL MANAGEMENT, LLC EIN 39-1541077 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $94K |
| BENEFIT PLAN ADMINISTRATION EIN 39-1400101 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $68K |
| FREYBERG HINKLE ASHLAND POWERS & ST EIN 39-1531945 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $16K |
| BMO FINANCIAL GROUP EIN 36-2085229 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $15K |
| UNITED ACTUARIAL SERVICES NONE | Direct payment from the plan; Actuarial Service code 11 | — | $7K |
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 | 695 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 695 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 695 | $117K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 695 | $117K |
| Stop-loss / reinsurancereinsurance | WISCONSIN PHYSICIANS SERVICE | 695 | $617K |
| Other | HARTFORD LIFE AND ACCIDENT | 695 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 695 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.