| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC | 6711 COLUMBIA GATEWAY DR SUITE 450 COLUMBIA, MD 21046 | SYMETRA LIFE INSURANCE COMPANY | $31K | — | $31K | 4.88% |
| UNITED OF OMAHA LIFE INSURANCE CO5 Filed as: UNITED OF OMAHA LIFE INSURANCE CO. | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $6K | $6K | 4.95% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 4.46% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 2.91% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 1.34% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SVCS INC | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $515 | — | $515 | 0.40% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SVCS INC | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $205 | — | $205 | 0.16% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SVCS INC | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $151 | — | $151 | 0.12% |
| R & R INSURANCE SERVICES INC3 Filed as: R&R INSURANCE SERVICES INC. | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | UNIFIED LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SVCS INC | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | WYSSTA INSURANCE COMPANY INC | $2K | — | $2K | 7.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441220 PHARMACY BENEFIT MANAGEME | Other fees; Claims processing; Float revenue Service code 12 | — | $904K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | 2700 MIDWEST DRIVE ONALASKA, WI 546508763 | $141K |
| HAYS COMPANIES OF WI EIN 41-1932108 BROKER | Other commissions Service code 55 | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | $40K |
| R&R INSURANCE SERVICES INC EIN 39-1230987 BROKER | Other commissions Service code 55 | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | $15K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 100 N. CORPORATE DR. STE 100 BROOKFIELD, WI 53045 | $13K |
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 | 285 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 289 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC | 137 | $26K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 285 | $129K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 285 | $129K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 285 | $129K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 207 | $629K |
| Other | UNIFIED LIFE INSURANCE COMPANY | 4 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 285 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.