| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN/JOHNSON | 700 REGENT ST PO BOX 259408 MADISON, WI 53725 | PHYSICIANS PLUS INSURANCE CORP | $22K | $2K | $24K | 1.11% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 537159408 | DELTA DENTAL OF WISCONSIN | $20K | — | $20K | 11.84% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN JOHNSON INSURANCE, INC | 700 REGENT ST MADISON, WI 537152634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 9.12% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 2.42% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN JOHNSON INSURANCE, INC | 700 REGENT ST MADISON, WI 537152634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN JOHNSON INSURANCE, INC | 700 REGENT ST MADISON, WI 537152634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $606 | $606 | 2.27% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 537159408 | WYSSTA INSURANCE COMPANY INC | $3K | — | $3K | 10.84% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN JOHNSON INSURANCE, INC | 700 REGENT ST MADISON, WI 537152634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | — |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSSING | Contract Administrator; Claims processing Service code 12 | — | $11K |
| HAUSMANN-JOHNSON INSURANCE, INC. BROKER | Insurance agents and brokers Service code 22 | 700 REGENT ST PO BOX 259408 MADISON, WI 53725 | $559 |
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 | 329 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 330 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PHYSICIANS PLUS INSURANCE CORP | 482 | $2.2M |
| Dental | DELTA DENTAL OF WISCONSIN | 245 | $171K |
| Vision | WYSSTA INSURANCE COMPANY INC | 182 | $26K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 308 | $54K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $0 |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 310 | $48K |
| Prescription drug | UNITY HEALTH PLANS INSURANCE CORPORATION | 0 | $374 |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 308 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 482 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.