| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JEFFRY BARTOSIC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | BLUERE OF TENNESSEE | $10K | — | $10K | 5.22% |
| ASSOCIATED FINANCIAL GROUP LLC3 Filed as: ASSOCIATED FINANCIAL GROUP, LLC | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | FOUR EVER LIFE INS CO. | $1K | $452 | $2K | 14.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CVS PHARMACY, INC EIN 05-0340626 CLAIMS PROCESSING | Float revenue; Other services; Direct payment from the plan; Participant communication; Non-monetary compensation; Named fiduciary; Claims processing; Contract Administrator Service code 12 | — | $284K |
| BLUE CROSS BLUE SHIELD OF WISCONSIN EIN 39-0138065 CLAIMS PROCESSING | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Float revenue; Contract Administrator Service code 12 | — | $239K |
| BCBST EIN 62-0427913 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $10K |
| INGENIORX, INC. EIN 82-3062245 CLAIMS PROCESSING | Contract Administrator; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | -$48K |
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 | 320 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 23 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 353 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUERE OF TENNESSEE | 631 | $203K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF WISCONSIN | 656 | $373K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 656 | — |
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."
No prospect flags tripped on this filing.