| 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 | QBE INSURANCE CORPORATION | $26K | $0 | $26K | 10.01% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | STANDARD INSURANCE COMPANY | $10K | $0 | $10K | 15.88% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | CARE-PLUS DENTAL PLANS, INC. | $1K | $0 | $1K | 6.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 NONE | Claims processing; Contract Administrator Service code 12 | 11 SCOTT STREET SE SUITE 100 WAUSAU, WI 544034808 | $66K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 NONE | Claims processing; Contract Administrator Service code 12 | 2801 HOOVER ROAD P.O. BOX 828 STEVENS POINT, WI 544817100 | $5K |
| M3 INSURANCE SOLUTIONS, INC. EIN 39-1141360 NONE | Insurance agents and brokers Service code 22 | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | $610 |
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 | 169 | 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) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CARE-PLUS DENTAL PLANS, INC. | 81 | $18K |
| Life insurance | STANDARD INSURANCE COMPANY | 173 | $65K |
| Short-term disability | STANDARD INSURANCE COMPANY | 173 | $65K |
| Long-term disability | STANDARD INSURANCE COMPANY | 173 | $65K |
| Stop-loss / reinsurancereinsurance | QBE INSURANCE CORPORATION | 115 | $260K |
| Other | NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA | 115 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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.