| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 700 REGENT ST STE 400 MADISON, WI 53715 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $37K | — | $37K | 1.14% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 537159408 | DELTA DENTAL OF WISCONSIN | $26K | — | $26K | 11.20% |
| BENEFITSTORE INC3 | 100 BENEFITFOCUS WAY CHARLESTON, SC 29492 | HARTFORD LIFE AND ACCIDENT | $6K | $690 | $7K | 8.40% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INS INC | PO BOX 250408 MADISON, WI 53725 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 2.51% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 537159408 | WYSSTA INSURANCE COMPANY INC | $4K | — | $4K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $26K |
| HAUSMANN-JOHNSON INSURANCE, INC. BROKER | Insurance agents and brokers Service code 22 | 740 REGENT ST 4TH FLOOR PO BOX 259408 MADISON, WI 53725 | $1K |
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 | 406 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 416 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 656 | $3.2M |
| Dental | DELTA DENTAL OF WISCONSIN | 331 | $234K |
| Vision | WYSSTA INSURANCE COMPANY INC | 259 | $39K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 248 | $80K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 248 | $80K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 248 | $80K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 656 | $3.2M |
| Other | HARTFORD LIFE AND ACCIDENT | 248 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 656 | — |
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.