| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS GREAT PLANES LLC | 4200 UNIVERSITY AVE STE 200 WEST DES MOINES, IA 50266 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $58K | — | $58K | 5.02% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS LLC DB | 2501 W BELTLINE HIGHWAY STE 201 MADISON, WI 537132321 | METROPOLITAN LIFE INSURANCE COMPANY | $29K | $4K | $33K | 14.24% |
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURERS GROUP INC | 1995 POINT TOWNSHIP DR NORTHUMBERLAN, PA 178578856 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | $9K | $20K | 8.64% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS LLC | 4200 UNIVERSITY AVE STE 200 WEST DES MOINES, IA 502665945 | METROPOLITAN LIFE INSURANCE COMPANY | — | $7K | $7K | 2.82% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 THIRD PARTY ADMINISTRATO | Claims processing; Contract Administrator Service code 12 | — | $7K |
| STAFFORD FINANCIAL CONSULTING GROUP BROKER | Insurance agents and brokers Service code 22 | 2501 W BELTLINE HIGHWAY #201 MADISON, WI 53713 | $316 |
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 | 112 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 195 | $1.2M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 271 | $234K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 271 | $234K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 271 | $234K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 271 | $234K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 271 | $234K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 195 | $1.2M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 271 | $234K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 271 | — |
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.