| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | N27 W23960 PAUL ROAD PEWAUKEE, WI 53072 | ANTHEM BCBS OF WISCONSIN | $46K | $46K | $93K | 29.78% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES | N27 W23960 PAUL ROAD PEWAUKEE, WI 53072 | LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 5.08% |
| NATIONAL BENEFIT CONSULTANTS, INC.3 | 208 EAST OAK CREST DRIVE WALES, WI 53183 | TRANSAMERICA PREMIER LIFE INSURANCE COMPANY | $12K | — | $12K | 11.00% |
| BURKWALD & ASSOCIATES3 | N27 W23960 PAUL ROAD PEWAUKEE, WI 53072 | TRANSAMERICA PREMIER LIFE INSURANCE COMPANY | $3K | — | $3K | 3.05% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | N27 W23960 PAUL ROAD PEWAUKEE, WI 53072 | TRANSAMERICA PREMIER LIFE INSURANCE COMPANY | $990 | — | $990 | 0.94% |
| NATIONAL BENEFITS CONSULTANTS, INC.3 | 208 EAST OAK CREST DRIVE WALES, WI 53183 | EXPRESS SCRIPTS | $3K | — | $3K | 2.55% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BCBS OF WISCONSIN EIN 39-0138065 TPA | Contract Administrator; Float revenue; Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees Service code 12 | N27 W24340 RIVERWOOD DRIVE PEWAUKEE, WI 53072 | $178K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 ADMINSTER EAP | Claims processing; Contract Administrator; Direct payment from the plan; Participant communication Service code 12 | — | $4K |
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 | 175 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 35 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 210 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TRANSAMERICA PREMIER LIFE INSURANCE COMPANY | 34 | $105K |
| Vision | EYE MED VISION CARE | 359 | $22K |
| Life insurance | LIFE INSURANCE COMPANY OF AMERICA | 159 | $124K |
| Short-term disability | LIFE INSURANCE COMPANY OF AMERICA | 159 | $124K |
| Long-term disability | LIFE INSURANCE COMPANY OF AMERICA | 159 | $124K |
| Prescription drug | EXPRESS SCRIPTS | 34 | $99K |
| Stop-loss / reinsurancereinsurance | ANTHEM BCBS OF WISCONSIN | 436 | $311K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 436 | — |
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.