| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREGORY BLUM3 | HEMB INSURANCE GROUP, LLC 2801 COHO ST, SUITE 200 MADISON, WI 53713 | DEAN HEALTH PLAN INC | $29K | — | $29K | 0.83% |
| HEMB INSURANCE GROUP LLC3 Filed as: HEMB INSURANCE GROUP | 2801 COHO STREET MADISON, WI 53713 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $563 | — | $563 | 5.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WEBTPA EIN 75-2611444 THIRD PARTY ADMINISTRATO | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $30K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATO | Direct payment from the plan; Contract Administrator Service code 13 | — | $22K |
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 INSURANCE BROKER | Insurance agents and brokers; Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $20K |
| HEMB INSURANCE GRP LLC INSURANCE AGENT OR BROKE | Direct payment from the plan; Insurance agents and brokers Service code 22 | 2801 COHO ST STE 200 GREGORY BLUM MADISON, WI 53713 | $371 |
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 | 478 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 136 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 614 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | DEAN HEALTH PLAN INC | 489 | $3.5M |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | 871 | $10K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 491 | $148K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 491 | $148K |
| Other | HARTFORD LIFE AND ACCIDENT | 491 | $148K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 871 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.