| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS INC | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | DELTA DENTAL OF WISCONSIN | $6K | — | $6K | 5.09% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS SERVICES | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $482 | $5K | 12.39% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS INC | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $838 | $24 | $862 | 4.76% |
| RICHARD HUDOCK3 Filed as: RICHARD A CONSENTINO | 111 E KILBOURN AVE, SUITE 800 MILWAUKEE, WI 53202 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $114 | — | $114 | 0.63% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS BENEIFTS GROUP OF WI | 1200 N MAYFAIR RS STE 100 MILWAUKEE, WI 53226 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $66 | — | $66 | 0.36% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS INC | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | UNITED HEALTHCARE INSURANCE COMPANY | $1K | $366 | $2K | 13.28% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARMACY BENEFIT MGMT | Float revenue; Claims processing; Other fees; Direct payment from the plan Service code 12 | — | $103K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $69K |
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 | 176 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 178 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 161 | $118K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 115 | $12K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 154 | $39K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 56 | $18K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 154 | $39K |
| Stop-loss / reinsurancereinsurance | QBE INSURANCE CORPORATION | 181 | $406K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 154 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 181 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.