| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BRAD NIEBUHR3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | DEAN HEALTH PLAN INC | $11K | — | $11K | 0.63% |
| JESSE OBERLOH3 | P.O. BOX 259408 MADISON, WI 53725 | DEAN HEALTH PLAN INC | $9K | — | $9K | 0.53% |
| NIEBUR, BRAD3 | 828 JOHN NOLEN DR. MADISON, WI 53713 | GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN | $10K | — | $10K | 2.75% |
| OBERLOH, JESSE D3 | 700 REGENT ST. MADISON, WI 53725 | GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN | $6K | — | $6K | 1.65% |
| M3 INSURANCE SOLUTIONS INC3 | 1610 WYNKOOP STREET SUITE 300 DENVER, CO 80202 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | $6K | $13K | 11.22% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN JOHNSON INS INC | 700 REGENT STREET MADISON, WI 53715 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 3.19% |
| C2 CENTRIC LLC3 | 11740 SW 68TH PARKWAY SUITE 2 PORTLAND, OR 97223 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $99 | — | $99 | 0.08% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS | 1610 WYNKOOP STREET SUITE 300 DENVER, CO 80202 | SUPERIOR VISION PLAN | $1K | — | $1K | 7.88% |
| HAUSMANN-JOHNSON INSURANCE INC3 | 700 REGENT ST MADISON, WI 53715 | SUPERIOR VISION PLAN | $412 | — | $412 | 2.95% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 TPA (DENTAL BENEFIT) | Contract Administrator Service code 13 | — | $8K |
| HAUSMANN-JOHNSON INSURANCE INC INS. AGENT OR BROKER | Insurance agents and brokers Service code 22 | PO BOX 259408 MADISON, WI 53715 | $1K |
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 | 186 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | DEAN HEALTH PLAN INC | 364 | $2.1M |
| Vision | SUPERIOR VISION PLAN | 164 | $14K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 186 | $117K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 186 | $117K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 186 | $117K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 186 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 364 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.