| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DR. MADISON, WI 53713 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $23K | — | $23K | 1.40% |
| M3 INSURANCE SOLUTIONS INC3 | PO BOX 8950 MADISON, WI 53708 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $12K | — | $12K | 1.67% |
| M3 INSURANCE SOLUTIONS INC3 | PO BOX 8950 MADISON, WI 53708 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $12K | — | $12K | 1.70% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | BLUE CROSS BLUE SHIELD OF WISCONSIN | $11K | — | $11K | 1.78% |
| M3 INSURANCE SOLUTIONS INC3 | PO BOX 8950 MADISON, WI 53708 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $4K | $12K | 15.66% |
| M3 INSURANCE SOLUTIONS INC3 | PO BOX 8950 MADISON, WI 53708 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $574 | $4K | 11.24% |
| M3 INSURANCE SOLUTIONS INC3 | PO BOX 8950 MADISON, WI 53708 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $519 | $4K | 10.08% |
| M3 INSURANCE SOLUTIONS INC3 | PO BOX 8950 MADISON, WI 53708 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $374 | $4K | 13.20% |
| M3 INSURANCE SOLUTIONS INC3 | PO BOX 8950 MADISON, WI 53708 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $238 | $2K | 11.46% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DR MADISON, WI 53713 | WYSSTA INSURANCE COMPANY INC. | $1K | — | $1K | 8.34% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | WYSSTA INSURANCE COMPANY INC | $841 | — | $841 | 8.29% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 NONE | Contract Administrator; Insurance agents and brokers Service code 13 | — | $20K |
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 | 412 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 415 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 265 | $3.7M |
| Vision(2 contracts) | WYSSTA INSURANCE COMPANY INC. | 125 | $25K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 411 | $116K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 57 | $16K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 105 | $67K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 265 | $1.7M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 411 | $116K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 411 | — |
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.