| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS | 100 N CORPORATE DR #100 BROOKFIELD, WI 53045 | SUN LIFE OF CANADA | $24K | — | $24K | 10.00% |
| UMR, INC.3 Filed as: UMR | 2700 MIDWEST DRIVE ONALASKA, WI 54650 | SUN LIFE OF CANADA | $12K | — | $12K | 5.00% |
| UMR, INC. Filed as: UMR INC | 2700 MIDWEST DRIVE ONALASKA, WI 54650 | SUN LIFE ASSURANCE COMPANY OF CANADA | $28K | — | $28K | 15.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS | 100 N CORPORATE DR #100 BROOKFIELD, WI 53045 | SUN LIFE ASSURANCE COMPANY OF CANADA | $12K | — | $12K | 10.02% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS INC | 100 N CORPORATE DR #100 BROOKFIELD, WI 53045 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | — | $6K | 7.59% |
| UNITED BENEFITS ADVISORS INC | 10 WYNSHIRE LANE RED LION, PA 17356 | SUN LIFE ASSURANCE COMPANY OF CANADA | $170 | — | $170 | 0.21% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SERVICES | 100 N CORPORATE DR #100 BROOKFIELD, WI 53045 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $1K | — | $1K | 9.04% |
| UNITED LIFE INSURANCE COMPANY3 | — | UNIFIED LIFE INSURANCE COMPANY | $300 | — | $300 | 20.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | 2700 MIDWEST DRIVE ONALASKA, WI 546508763 | $62K |
| DIVERSIFIED INSURANCE SOLUTIONS EIN 39-1403176 BROKER | Other commissions Service code 55 | 100 N. CORPORATE DR. STE 100 BROOKFIELD, WI 53045 | $10K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 100 N. CORPORATE DR. STE 100 BROOKFIELD, WI 53045 | $7K |
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 | 202 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 205 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIFIED LIFE INSURANCE COMPANY | 3 | $2K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | 164 | $11K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 202 | $80K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 202 | $80K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 202 | $80K |
| Stop-loss / reinsurancereinsurance(3 contracts, 2 carriers) | SUN LIFE OF CANADA | 149 | $543K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 202 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.