| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFIT SERVICES GROUP, INC.3 Filed as: BENEFIT SERVICES GROUP INC | PO BOX 78117 MILWAUKEE, WI 53278 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 10.00% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $42 | $42 | 0.03% |
| BENEFIT SERVICES GROUP, INC.3 Filed as: THE BENEFIT SERVICES GROUP INC | PO BOX 6762 CAROL STREAM, IL 60197 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 15.31% |
| BENEFIT SERVICES GROUP, INC.3 Filed as: THE BENEFIT SERVICES GROUP INC. | N25 W23050 PAUL ROAD PEWAUKEE, WI 53072 | GERBER LIFE INSURANCE COMPANY | $215 | — | $215 | 14.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATO | Contract Administrator Service code 13 | — | $6K |
| THE BENEFIT SERVICES GROUP INC BROKER | Insurance agents and brokers Service code 22 | PO BOX 6762 CAROL STREAM, IL 60197 | $112 |
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 | 127 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMPCARE HEALTH SERVICES INSURANCE CORPORATION | 45 | $272K |
| Vision | VISION SERVICE PLAN | 73 | $9K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 276 | $137K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 276 | $137K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 276 | $137K |
| Prescription drug | UNITY HEALTH PLANS INSURANCE CORPORATION | 165 | $814K |
| Other(3 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 276 | $181K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 276 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.