| 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 537131424 | DEAN HEALTH PLAN, INC. | $15K | $0 | $15K | 2.40% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 12.77% |
| GREAT LAKES INSURANCE CONSULTANTS3 | 1166 QUAIL COURT SUITE 100 PEWAUKEE, WI 53072 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $49 | $0 | $49 | 0.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATO | Contract Administrator; Claims processing Service code 12 | 2801 HOOVER ROAD P.O. BOX 828 STEVENS POINT, WI 544817100 | $3K |
| M3 INSURANCE SOLUTIONS, INC. EIN 39-1141360 INSURANCE AGE NT OR BROKE | Insurance agents and brokers Service code 22 | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | $988 |
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 | 103 | 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) | 104 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | DEAN HEALTH PLAN, INC. | 89 | $629K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 101 | $38K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 101 | $38K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 101 | $38K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 101 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 101 | — |
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.