| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITAL SPECIAL RISKS3 | 1899 POWERS FERRY ROAD, SUITE 100 ATLANTA, GA 30339 | HCC LIFE INSURANCE COMPANY | $0 | $24K | $24K | 5.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT PLAN ADMINISTRATION OF WI EIN 39-1400101 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $271K |
| UNITED HEALTH CARE EIN 36-2739571 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $207K |
| LEE JOST & ASSOCIATES EIN 39-1400101 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $36K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $24K |
| FREYBERG HINKLE ET AL EIN 39-1531945 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $12K |
| BUILDING TRADES UNITED PENSION EIN 51-6049409 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $9K |
| THE PREVIANT LAW FIRM NONE | Legal; Direct payment from the plan Service code 29 | 310 WEST WISCONSIN AVE SUITE 100 MW MILWAUKEE, WI 53203 | $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 | 395 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 167 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 562 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 436 | $442K |
| Other | AIG BENEFIT SOLUTIONS, MEDICAL EXCESS | 437 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 437 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.