| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $39K | — | $39K | 14.94% |
| UMR, INC.3 Filed as: UMR INC | 2700 MIDWEST DRIVE ONALASKA, WI 54602 | WESTPORT INSURANCE CORP | — | $136K | $136K | 54.49% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | WESTPORT INSURANCE CORP | — | $6K | $6K | 2.47% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | VISION SERVICE PLAN | — | $1K | $1K | 4.17% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 234662817 | VISION SERVICE PLAN | — | $201 | $201 | 0.75% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DR KIMBERLY, WI 54136 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 19.50% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 541362142 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 20.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 3RD PARTY ADMIN - DENTAL | Contract Administrator Service code 13 | — | $13K |
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 | 475 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 475 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | WESTPORT INSURANCE CORP | 265 | $250K |
| Vision | VISION SERVICE PLAN | 257 | $27K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 425 | $261K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 425 | $261K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 425 | $261K |
| Stop-loss / reinsurancereinsurance | WESTPORT INSURANCE CORP | 265 | $250K |
| Other(3 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 425 | $289K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 425 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.