| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WALSER INSURANCE LLC3 | 4401 AMERICAN BLVD W BLOOMINGTON, MN 55437 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $442 | $0 | $442 | 1.66% |
| MIDWEST SELECT INSURANCE GROUP LLC3 Filed as: MIDWEST SELECT INS GRP LLC | 1431 OKEEFE AVE KRONENWETTER, WI 54455 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $262 | $0 | $262 | 0.98% |
| SANTA CRUZ CHARLOTTE R3 | 718 DUNBAR AVENUE SUITE 3A ST LOUIS, MO 39520 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $123 | $0 | $123 | 0.46% |
| SCS BENEFIT SERVICES LLC3 | 1101 W CLAIREMONT AVE STE 2E EAU CLAIRE, WI 54701 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $121 | $0 | $121 | 0.45% |
| DOOLEY HOLLY L3 | 1101 W CLAIREMONT AVENUE SUITE 2E EU CLAIRE, WI 54701 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $93 | $0 | $93 | 0.35% |
| BARNUM DANIEL3 | 1311 PIEDMONT RD EU CLAIRE, WI 54703 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $69 | $0 | $69 | 0.26% |
| KLINER MARY3 | 15237 224TH AVE BLOOMER, WI 54724 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $43 | $0 | $43 | 0.16% |
| RACANELLI MARIO3 | 3717 FAIRFAX STREET EAU CLAIRE, WI 54701 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $43 | $0 | $43 | 0.16% |
| KIEKOW NICHOLAS3 | N53W33177 LINDEN CIRCLE EAST NASHOTAH, WI 53058 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $22 | $0 | $22 | 0.08% |
| WENGER ERIC W3 | 17909 HIGHWAY 7 MINNETONKA, MN 55345 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $4 | $0 | $4 | 0.01% |
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 | 66 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 77 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Other | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 66 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 66 | — |
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.