| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES OF WI | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | TOKIO MARINE | $38K | — | $38K | 10.00% |
| 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 | — | $5K | $5K | 6.20% |
| 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 | $5K | — | $5K | 5.48% |
| 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 | $3K | — | $3K | 3.09% |
| 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 | $1K | — | $1K | 1.61% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | UNIFIED LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES OF WISCONSIN | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | $2K | — | $2K | 9.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441220 PHARMACY BENEFIT MANAGEME | Direct payment from the plan; Float revenue; Claims processing; Other fees Service code 12 | — | $259K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | 2700 MIDWEST DRIVE ONALASKA, WI 546508763 | $78K |
| HAYS COMPANIES EIN 41-1932108 INSURANCE AGENT OR BROKER | Insurance agents and brokers; Other commissions Service code 22 | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | $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 | $10K |
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 | 259 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 264 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIFIED LIFE INSURANCE COMPANY | 5 | $39K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | 114 | $20K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 259 | $84K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 259 | $84K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 259 | $84K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 194 | $383K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 259 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.