| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SERVICES INC | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $30K | — | $30K | 1.10% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | CAREFIRST BLUECHOICE, INC. | — | $18K | $18K | 1.81% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE | 828 JOHN NOLEN DR MADISON, WI 53713 | CAREFIRST BLUECHOICE, INC. | — | $13K | $13K | 1.30% |
| AMWINS5 Filed as: AMWINS CONNECT ADMINISTRATORS, INC | 11350 MCCORMICK ROAD EXECUTIVE PLAZA IV, SUITE 400 COCKEYSVILLE, MD 21031 | CAREFIRST BLUECHOICE, INC. | — | $4K | $4K | 0.36% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $5K | $14K | 7.02% |
| WATCHTOWER TECHNOLOGIES INC3 | 306 WEST ERIE ST SUITE #300 CHICAGO, IL 60654 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 1.50% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DR MADISON, WI 53713 | VISION SERVICE PLAN | $2K | — | $2K | 7.21% |
| WATCHTOWER TECHNOLOGIES INC3 | 306 WEST ERIE ST STE #300 CHICAGO, IL 60654 | VISION SERVICE PLAN | $202 | — | $202 | 0.65% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 702 KING FARM BLVD STE 210 ROCKVILLE, MD 20850 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 6.67% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DR MADISON, WI 53713 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $965 | — | $965 | 3.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 736 S STONE AVE LA GRANGE, IL 60523 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $597 | $597 | 2.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 702 KING FARM BLVD STE 210 ROCKVILLE, MD 20850 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 9.94% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $919 | — | $919 | 5.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 736 S STONE AVE LA GRANGE, IL 60523 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $372 | $372 | 2.05% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 702 KING FARM BLVD STE 210 ROCKVILLE, MD 20850 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $732 | — | $732 | 6.69% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DR MADISON, WI 53713 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $362 | — | $362 | 3.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 736 S STONE AVE LA GRANGE, IL 60523 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $223 | $223 | 2.04% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | FIRST UNUM LIFE INSURANCE COMPANY | $112 | $20 | $132 | 17.69% |
| WATCHTOWER TECHNOLOGIES INC3 Filed as: WATCHTOWER TECHNOLOGIES | 306 WEST ERIE ST SUITE #300 CHICAGO, IL 60654 | FIRST UNUM LIFE INSURANCE COMPANY | $26 | — | $26 | 3.49% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | FEDERAL INSURANCE COMPANY | $102 | — | $102 | 15.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE EIN 59-1031071 CLAIMS PROCESSING | Claims processing; Insurance services Service code 12 | — | $76K |
| GALLAGHER BENEFIT SERVICES INS AGENTS AND BROKERS | Insurance agents and brokers Service code 22 | 736 S STONE AVE LA GRANGE, IL 60525 | $15K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 TPA (DENTAL BENEFIT) | Contract Administrator Service code 13 | — | $14K |
| M3 INSURANCE SOLUTIONS INC INS AGENTS AND BROKERS | Insurance agents and brokers Service code 22 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | $12K |
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $5K |
| CIGNA | Other services; Float revenue; Direct payment from the plan; Contract Administrator; Participant communication; Named fiduciary; Claims processing; Non-monetary compensation Service code 12 | — | $0 |
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 | 248 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 93 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 343 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 276 | $3.7M |
| Vision | VISION SERVICE PLAN | 226 | $31K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 213 | $210K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 40 | $29K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 213 | $217K |
| Prescription drug(2 contracts, 2 carriers) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 276 | $3.7M |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 98 | $429K |
| Other(4 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 290 | $211K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 290 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.