| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 3113 WEST BELTLINE HIGHWAY MADISON, WI 53713 | UNITY HEALTH PLANS INSURANCE CORPORATION | $16K | — | $16K | 1.67% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | PO BOX 8950 MADISON, WI 537088950 | PREMERA BLUE CROSS | $40K | — | $40K | 5.00% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 3113 WEST BELTLINE HIGHWAY MADISON, WI 53708 | GUNDERSEN HEALTH PLAN, INC. | $12K | — | $12K | 4.19% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | PO BOX 8950 MADISON, WI 537088950 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $2K | $9K | 15.13% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | PO BOX 8950 MADISON, WI 537088950 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $5K | 15.64% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | PO BOX 8950 MADISON, WI 537088950 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 13.96% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DR MADISON, WI 537130000 | WYSSTA INSURANCE COMPANY INC. | $1K | — | $1K | 7.37% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | PO BOX 8950 MADISON, WI 537088950 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $490 | $3K | 18.63% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 NONE | Contract Administrator Service code 13 | — | $12K |
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 | 341 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 341 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | UNITY HEALTH PLANS INSURANCE CORPORATION | 178 | $2.1M |
| Vision | WYSSTA INSURANCE COMPANY INC. | 108 | $15K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 349 | $91K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 139 | $44K |
| Prescription drug(2 contracts, 2 carriers) | UNITY HEALTH PLANS INSURANCE CORPORATION | 178 | $1.8M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 349 | $91K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 349 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.