| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEMB INSURANCE GROUP LLC Filed as: HEMB INSURANCE GROUP, LLC | 2801 COHO ST SUITE 200 MADISON, WI 53713 | DEAN HEALTH PLAN | $3K | — | $3K | 1.14% |
| M3 INSURANCE SOLUTIONS INC Filed as: M3 INSURANCE SOLUTIONS, INC | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | DEAN HEALTH PLAN | $285 | — | $285 | 0.11% |
| BYRNE, BYRNE AND COMPANY3 Filed as: BYRNE BYRNE & CO | 120 S. LASALLE ST SUITE 1710 CHICAGO, IL 60603 | SUN LIFE ASSURANCE COMPANY OF CANADA | $10K | — | $10K | 4.62% |
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS COALITION SERVICES LLC | 7632 SW DURHAM RD SUITE 115 TIGARD, OR 97224 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | — | $5K | 2.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $325K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIMS ADMINISTRATOR | Non-monetary compensation; Claims processing; Other services; Float revenue; Named fiduciary; Participant communication; Contract Administrator; Direct payment from the plan Service code 12 | — | $27K |
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 | 450 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 19 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 469 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | DEAN HEALTH PLAN | 52 | $251K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 484 | $206K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 484 | — |
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.