| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UMR, INC.3 | 11 SCOTT ST STE 100 WAUSAU, WI 54403 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $3K | $3K | 0.65% |
| M3 INSURANCE SOLUTIONS INC3 | P O BOX 8950 828 JOHN NOLEN DRIVE MADISON, WI 53708 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $910 | $5K | 18.76% |
| M3 INSURANCE SOLUTIONS INC3 | PO BOX 8950 828 JOHN NOLEN DRIVE MADISON, WI 53708 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $871 | $3K | 12.01% |
| M3 INSURANCE SOLUTIONS INC3 | PO BOX 8950 828 JOHN NOLEN DRIVE MADISON, WI 53708 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $724 | $3K | 17.89% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 53715 | WYSSTA INSURANCE COMPANY INC | $957 | — | $957 | 8.36% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $103K |
| HAUSMANN-JOHNSON INSURANCE INC EIN 39-1090217 BROKER | Other commissions Service code 55 | — | $39K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $6K |
| INGENIUM PRIME INC INSURANCE AGENT OR BROKE | Insurance agents and brokers Service code 22 | PO BOX 259408 MADISON, WI 53715 | $867 |
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 | 168 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC | 77 | $11K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 185 | $23K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 54 | $24K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 185 | $19K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 112 | $466K |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 185 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 185 | — |
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.