| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DR STE 400 VALHALLA, NY 10595 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $18K | — | $18K | 1.14% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLAN DR MADISON, WI 53713 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $6K | — | $6K | 0.38% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DR KIMBERLY, WI 541360000 | WYSSTA INSURANCE COMPANY, INC. | $875 | — | $875 | 8.00% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLAN DR MADISON, WI 53713 | WYSSTA INSURANCE COMPANY, INC. | — | — | $0 | 0.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 234662817 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $2K | $4K | — |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLAN DR MADISON, WI 537131424 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | — |
No Schedule C service providers reported on this filing.
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 | 254 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 254 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 223 | $1.6M |
| Vision | WYSSTA INSURANCE COMPANY, INC. | 102 | $11K |
| Life insurance | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 254 | $23K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 60 | $0 |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 60 | $0 |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 223 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 254 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.