| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WALSER INSURANCE LLC3 | 4401 AMERICAN BLVD W BLOOMINGTON, MN 55437 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $584 | — | $584 | 1.65% |
| MIDWEST SELECT INSURANCE GROUP LLC3 Filed as: MIDWEST SELECT INS GROUP LLC | P O BOX 207 MOSINEE, WI 54455 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $342 | — | $342 | 0.97% |
| STEVEN SCULLION3 | 1101 W CLAIREMONT AVENUE SUITE 2E EAU CLAIRE, WI 54701 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $167 | — | $167 | 0.47% |
| CHARLOTTE R SANTA CRUZ3 | 718 DUNBAR AVENUE SUITE 3A BAY ST LOUIS, MS 39520 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $159 | — | $159 | 0.45% |
| HOLLY DOOLEY3 | 1101 W CLAIREMONT AVENUE SUITE 2E EAU CLAIRE, WI 54701 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $136 | — | $136 | 0.38% |
| DANIEL BARNUM3 | 1311 PIEDMONT RD EAU CLAIRE, WI 54703 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $84 | — | $84 | 0.24% |
| MARY KLINER3 | 15237 224TH AVENUE BLOOMER, WI 54724 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $72 | — | $72 | 0.20% |
| MARIO RACANELLI3 Filed as: MARIO RACANELLO | 3717 FAIRFAX STREET EAU CLAIRE, WI 54701 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $41 | — | $41 | 0.12% |
| NICHOLAS KIEKOW3 | N53W33177 LINDEN CIRCLE EAST NASHOTAH, WI 53058 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $24 | — | $24 | 0.07% |
| ERIC W WENGER3 | 17909 HIGHWAY 7 MINNETONKA, MN 55345 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $6 | — | $6 | 0.02% |
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 | 100 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Other | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 100 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 100 | — |
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.