| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITEDHEALTHCARE INSURANCE COMPANY | $11K | — | $11K | 22.53% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 6.75% |
| CARUTH, JENNON, M3 Filed as: CARUTH, JENNON M | PO BOX 46122 EDEN PRAIRIE, MN 55344 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $730 | $25 | $755 | 11.82% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $585 | $15 | $600 | 9.39% |
| ASSUREX GLOBAL CORPORATION3 | STE 360 6620 MOONEY ST DUBLIN, OH 43017 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $22 | $22 | 0.34% |
| CARUTH, JENNON, M3 Filed as: CARUTH, JENNON M | PO BOX 46122 EDEN PRAIRIE, MN 55344 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $369 | $18 | $387 | 9.07% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $340 | $8 | $348 | 8.16% |
| ASSUREX GLOBAL CORPORATION3 | STE 360 6620 MOONEY ST DUBLIN, OH 43017 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | — | $0 | 0.00% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNUM INSURANCE COMPANY | $280 | $46 | $326 | 7.72% |
| CARUTH, JENNON, M3 Filed as: CARUTH, JENNON M | PO BOX 46122 EDEN PRAIRIE, MN 55344 | UNUM INSURANCE COMPANY | $141 | $12 | $153 | 3.62% |
| ASSUREX GLOBAL CORPORATION3 | STE 360 6620 MOONEY ST DUBLIN, OH 43017 | UNUM INSURANCE COMPANY | $0 | — | $0 | 0.00% |
No Schedule C service providers reported on this filing.
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 | 109 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 105 | $32K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 105 | $32K |
| Life insurance(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 105 | $55K |
| Short-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 105 | $49K |
| Long-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 105 | $49K |
| Other(3 contracts, 3 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 105 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 105 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.