| 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 | DELTA DENTAL OF WISCONSIN | $11K | $0 | $11K | 8.09% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | DELTA DENTAL OF WISCONSIN | $6K | $0 | $6K | 8.37% |
| EOI SERVICE COMPANY INC3 Filed as: EOI SERVICE COMPANY, INC. | 1820 EAST FIRST STREET SUITE 400 SANTA ANA, CA 92705 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $874 | $7K | 11.37% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $165 | $4K | 5.96% |
| JAMES D DAVIDSON3 Filed as: JAMES D. DAVIDSON | 1820 EAST FIRST STREET SUITE 400 SANTA ANA, CA 92868 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 1.77% |
| SPETNER ASSOCIATES INC3 Filed as: SPETNER ASSOCIATES, INC. | 8630 DELMAR AVENUE SUITE 100 ST. LOUIS, MO 63124 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $612 | $0 | $612 | 1.01% |
| JAMES W HAMBY3 Filed as: JAMES W. HAMBY | 503 FORREST PARK COURT HUNTSVILLE, AL 35806 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $205 | $0 | $205 | 0.34% |
| JONATHAN S. SPETNER3 | 8630 DELMAR AVENUE SUITE 100 ST. LOUIS, MO 63124 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $15 | $0 | $15 | 0.02% |
| ALAN E. RUTLEDGE3 | 8630 DELMAR AVENUE SUITE 100 ST. LOUIS, MO 63124 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.02% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $382 | $3K | 15.36% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $858 | $172 | $1K | 11.07% |
| JACK HEMB3 Filed as: JACK L. HEMB | 2801 COHO STREET SUITE 200 MADISON, WI 537134531 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 13.79% |
| C2 CENTRIC LLC3 | P.O. BOX 6824 GRAND RAPIDS, MI 49516 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $117 | $117 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 NONE | Contract Administrator; Claims processing Service code 12 | 11 SCOTT STREET SUITE 100 WAUSAU, WI 544034808 | $201K |
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 | 580 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 584 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | DELTA DENTAL OF WISCONSIN | 302 | $217K |
| Life insurance(4 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 430 | $91K |
| Short-term disability(2 contracts) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 195 | $60K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 14 | $8K |
| Stop-loss / reinsurancereinsurance | ZURICH NORTH AMERICAN INSURANCE COMPANY | 471 | $477K |
| Other(4 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 430 | $91K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 471 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.