| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | HARTFORD LIFE AND ACCIDENT | $12K | $0 | $12K | 5.75% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | WYSSTA INSURANCE COMPANY INC. | $3K | $0 | $3K | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT PLAN ADMINISTRATORS EIN 39-0819344 CLAIMS PROCESSING | Claims processing Service code 12 | GRAHAM RIVERSIDE BUILDING 402 GRAHAM AVENUE EAU CLAIRE, WI 547021128 | $176K |
| M3 INSURANCE SOLUTIONS, INC. EIN 39-1141360 INSURANCE BROKER | Insurance agents and brokers Service code 22 | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | $86K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 2801 HOOVER ROAD P.O. BOX 828 STEVENS POINT, WI 544817100 | $19K |
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 | 778 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 782 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC. | 262 | $42K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 778 | $201K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 778 | $201K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 363 | $710K |
| Other | HARTFORD LIFE AND ACCIDENT | 778 | $201K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 778 | — |
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.