| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | PO BOX 510187 NEW BERLIN, WI 531510187 | UNITEDHEALTHCARE INSURANCE COMPANY | $23K | — | $23K | 2.17% |
| ACRISURE LLC3 | 17901 GAWTHROP DRIVE UNIT 104 BRANDENTON, FL 34211 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $461 | $461 | 0.04% |
| THE HORTON GROUP3 Filed as: THE HORTON GROUP, INC | 10320 ORLAND PARKWAY ORLAND PARK, IL 60647 | DELTA DENTAL OF WISCONSIN | $2K | — | $2K | 6.21% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 510187 NEW BERLIN, WI 53151 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 9.47% |
| THE HORTON GROUP3 Filed as: THE HORTON GROUP, INC. | 10320 ORLAND PARKWAY ORLAND PARK, IL 60647 | HARTFORD LIFE AND ACCIDENT | $895 | — | $895 | 3.43% |
| VIZANCE, INC.3 | 2501 E ENTERPRISE AVE SUITE 301 APPLETON, WI 54913 | HARTFORD LIFE AND ACCIDENT | $2 | — | $2 | 0.01% |
| AGENTS OF COLONIAL (SEE ATTACHED)3 Filed as: AGENTS BREAKDOWN NOT LISTED | — | WYSSTA INSURANCE COMPANY, INC. | $499 | — | $499 | 8.00% |
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 | 148 | 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) | 149 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 138 | $1.0M |
| Dental | DELTA DENTAL OF WISCONSIN | 89 | $34K |
| Vision | WYSSTA INSURANCE COMPANY, INC. | 71 | $6K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 148 | $26K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 148 | $26K |
| Other | HARTFORD LIFE AND ACCIDENT | 148 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 148 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.