| 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 ASSURANCE COMPANY OF CANADA | $37K | — | $37K | 9.96% |
| UMR, INC.3 | 2700 MIDWEST DRIVE ONALASKA, WI 54650 | SUN LIFE ASSURANCE COMPANY OF CANADA | $55K | — | $55K | 15.00% |
| UMR, INC.3 Filed as: UMR | 5151 PFEIFFER RD ML 400 CINCINNATI, OH 45242 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 0.66% |
| 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 | 7.60% |
| UNITED LIFE INSURANCE COMPANY3 | — | UNIFIED LIFE INSURANCE COMPANY | $150 | — | $150 | 0.86% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTION | 100 N CORPORATE DR #100 BROOKFIELD, WI 53045 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $1K | — | $1K | 9.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | 2700 MIDWEST DRIVE ONALASKA, WI 546508763 | $77K |
| DIVERSIFIED INSURANCE SOLUTIONS EIN 39-1403176 BROKER | Other commissions Service code 55 | 100 N. CORPORATE DR. STE 100 BROOKFIELD, WI 53045 | $11K |
| 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 | 204 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 207 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIFIED LIFE INSURANCE COMPANY | 3 | $17K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 161 | $15K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 204 | $79K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 204 | $79K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 204 | $79K |
| Stop-loss / reinsurancereinsurance(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 159 | $741K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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.