| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS SERVICES INC | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | DELTA DENTAL OF WISCONSIN | $6K | $0 | $6K | 5.06% |
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP OF WISCONSIN | PO BOX 1414 MINNEAPOLIS, MN 55480 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 10.68% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS SERVICES | — | UNUM LIFE INSURANCE COMPANY OF AMERICA | $561 | $40 | $601 | 1.88% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 SOUTH 8TH ST, SUITE 700 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $535 | $535 | 1.67% |
| RICHARD HUDOCK3 Filed as: RICHARD A COSENTINO | 111 E KILBOURN AVE SUITE 800 MILWAUKEE, WI 53202 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $156 | $0 | $156 | 1.26% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFIT GROUP OF WISCONSIN | 1200 N MAYFAIR RD SUITE 100 MILWAUKEE, WI 53226 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $126 | -$1 | $125 | 1.01% |
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP OF WISCONSIN | PO BOX 1414 MINNEAPOLIS, MN 55480 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 12.44% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SERVICES | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $312 | $16 | $328 | 2.69% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 SOUTH 8TH ST, SUITE 700 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $202 | $202 | 1.65% |
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP OF WI LLC | 1200 N MAYFAIR RD SUITE 100 MILWAUKEE, WI 53226 | UNITED HEALTHCARE INSURANCE COMPANY | $842 | $0 | $842 | 7.45% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS SERVICES INC | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | UNITED HEALTHCARE INSURANCE COMPANY | $286 | $0 | $286 | 2.53% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $48K |
| HAYS COMPANIES OF WISCONSIN EIN 41-1932108 BROKER | Other commissions Service code 55 | — | $1K |
| DIVERSIFIED INSURANCE SOLUTIONS EIN 39-1403176 BROKER | Other commissions Service code 55 | — | $438 |
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 | 210 | 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) | 210 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 135 | $114K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 55 | $11K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 210 | $32K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 45 | $12K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 210 | $44K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 210 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.