| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DR BLOOMINGTON, MN 55437 | UNITEDHEALTHCARE INSURANCE COMPANY | $35K | — | $35K | 0.70% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITEDHEALTHCARE INSURANCE COMPANY | $18K | — | $18K | 0.36% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | DELTA DENTAL OF SOUTH DAKOTA | $2K | — | $2K | 0.73% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC | PO BOX 8950 MADISON, WI 53708 | RELIASTAR LIFE INSURANCE COMPANY | $14K | — | $14K | 7.42% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | RELIASTAR LIFE INSURANCE COMPANY | $13K | — | $13K | 6.94% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DR STE 400 VALHALLA, NY 10595 | RELIASTAR LIFE INSURANCE COMPANY | — | $9K | $9K | 4.75% |
| C2 CENTRIC LLC3 | 8804 S WINNIPEG CT AURORA, CO 80016 | RELIASTAR LIFE INSURANCE COMPANY | — | $997 | $997 | 0.52% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | VISION SERVICE PLAN | $1K | — | $1K | 2.25% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $1K | — | $1K | 2.23% |
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 | 439 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 441 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 131 | $5.1M |
| Dental | DELTA DENTAL OF SOUTH DAKOTA | 672 | $216K |
| Vision | VISION SERVICE PLAN | 299 | $65K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 1,550 | $193K |
| Other(2 contracts) | RELIASTAR LIFE INSURANCE COMPANY | 1,550 | $195K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,550 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.