| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITEDHEALTHCARE INSURANCE COMPANY | $17K | — | $17K | 1.47% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | COMMUNITY INSURANCE COMPANY | $8K | — | $8K | 1.97% |
| ONE80 INTERMEDIARIES INC3 Filed as: ONE80 INTERMEDIARIES INC. | 4555 LAKE FOREST DRIVE CINCINNATI, OH 45242 | COMMUNITY INSURANCE COMPANY | — | $4K | $4K | 0.87% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 5.15% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | — | $5K | 9.51% |
| C2 CENTRIC LLC3 | PO BOX 6824 GRAND RAPIDS, MD 49516 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $110 | $110 | 0.20% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WA 53713 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | $1K | $4K | 14.96% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | WYSSTA INSURANCE COMPANY INC. | $1K | — | $1K | 8.09% |
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 | 129 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 169 | $1.6M |
| Dental | DELTA DENTAL OF WISCONSIN | 101 | $88K |
| Vision | WYSSTA INSURANCE COMPANY INC. | 91 | $13K |
| Life insurance(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 83 | $78K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 83 | $54K |
| Long-term disability(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 83 | $78K |
| Other(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 83 | $78K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 169 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.