| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 740 REGENT ST STE 400 MADISON, WI 53715 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $28K | — | $28K | 1.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 650 EAST CARMEL DR STE 350 CARMEL, IN 46032 | HARTFORD LIFE AND ACCIDENT | $13K | $3K | $16K | 18.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | HARTFORD LIFE AND ACCIDENT | — | $958 | $958 | 1.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 650 EAST CARMEL DR STE 350 CARMEL, IN 46032 | HARTFORD LIFE AND ACCIDENT | $8K | $3K | $11K | 13.35% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | HARTFORD LIFE AND ACCIDENT | — | $1K | $1K | 1.31% |
| BUCHHOLZ PLANNING CORPORATION3 | 120 E LAKESIDE ST STE 260 MADISON, WI 53715 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 15.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 7818 BIG SKY DR STE 112 MADISON, WI 53719 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 16.37% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 740 REGENT ST STE 400 MADISON, WI 53715 | VISION SERVICE PLAN | $1K | — | $1K | 5.59% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 650 EAST CARMEL DR STE 350 CARMEL, IN 46032 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | HARTFORD LIFE AND ACCIDENT | — | $97 | $97 | 0.88% |
| BUCHHOLZ PLANNING CORPORATION3 | 120 E LAKESIDE ST STE 260 MADISON, WI 53715 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 15.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 650 EAST CARMEL DR STE 350 CARMEL, IN 46032 | HARTFORD LIFE AND ACCIDENT | $592 | — | $592 | 15.03% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | HARTFORD LIFE AND ACCIDENT | — | $41 | $41 | 1.04% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 537159408 | DELTA DENTAL OF WISCONSIN | $716 | — | $716 | — |
No Schedule C service providers reported on this filing.
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 | 264 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 14 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 278 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 196 | $0 |
| Vision | VISION SERVICE PLAN | 166 | $19K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 266 | $88K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 266 | $81K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 480 | $2.7M |
| Other(5 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 35 | $128K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 480 | — |
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.