| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES INC. | N14W23900 STONE RIDGE DR. WAUKESHA, WI 531881135 | WISCONSIN COLLABORATIVE INSURANCE COMPANY | $30K | — | $30K | 5.75% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES INC | N14 W23900 STONE RIDGE DR. WAUKESHA, WI 53188 | DELTA DENTAL OF WISCONSIN | $9K | — | $9K | 9.37% |
| VELTUS FINANCIAL SERVICES LLC3 Filed as: VELTUS FINANCIAL SERVICES, LLC | 7033 WASHINGTON AVE 101 RACINE, WI 53406 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $9K | — | $9K | 15.00% |
| MICHAEL DAVID RUZEK3 | 515 SCOTT DRIVE GREEN BAY, WI 54303 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $7K | — | $7K | 12.00% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $463 | $3K | 5.77% |
| SHAWN MANGAN3 | 1028 S. TAYLOR DRIVE SHEBOYGAN, WI 53081 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 3.00% |
| VELTUS FINANCIAL SERVICES LLC3 Filed as: VELTUS FINANCIAL SERVICES, LLC | 7033 WASHINGTON AVE 101 RACINE, WI 53406 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 7.50% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $429 | $2K | 6.13% |
| MICHAEL DAVID RUZEK3 | 515 SCOTT DRIVE GREEN BAY, WI 54303 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 6.00% |
| SHAWN MANGAN3 | 1028 S. TAYLOR DRIVE SHEBOYGAN, WI 53081 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $569 | — | $569 | 1.50% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES, INC. | N14 W23900 STONE RIDGE DR. WAUKESHA, WI 53188 | WYSSTA INSURANCE COMPANY INC. | $1K | — | $1K | 8.12% |
| VELTUS FINANCIAL SERVICES LLC3 Filed as: VELTUS FINANCIAL SERVICES, LLC | 7033 WASHINGTON AVE 101 RACINE, WI 53406 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $906 | — | $906 | 7.13% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $604 | $148 | $752 | 5.92% |
| MICHAEL DAVID RUZEK3 | 515 SCOTT DRIVE GREEN BAY, WI 54303 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $725 | — | $725 | 5.70% |
| SHAWN MANGAN3 | 1028 S. TAYLOR DRIVE SHEBOYGAN, WI 53081 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $181 | — | $181 | 1.42% |
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 | 220 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 221 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | WISCONSIN COLLABORATIVE INSURANCE COMPANY | 117 | $521K |
| Dental | DELTA DENTAL OF WISCONSIN | 135 | $93K |
| Vision(2 contracts, 2 carriers) | WISCONSIN COLLABORATIVE INSURANCE COMPANY | 183 | $538K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 342 | $13K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 65 | $60K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 341 | $38K |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 342 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 342 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.