| 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 | $12K | $0 | $12K | 8.86% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | DELTA DENTAL OF WISCONSIN | $6K | $0 | $6K | 9.86% |
| 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 | $543 | $7K | 11.94% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $270 | $3K | 6.05% |
| SPETNER ASSOCIATES INC3 Filed as: SPETNER ASSOCIATES, INC. | 8630 DELMAR AVENUE SUITE 100 ST. LOUIS, MO 63124 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $526 | $0 | $526 | 0.94% |
| JAMES W HAMBY3 Filed as: JAMES W. HAMBY | 503 FORREST PARK COURT HUNTSVILLE, AL 35806 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $182 | $0 | $182 | 0.33% |
| JAMES D DAVIDSON3 Filed as: JAMES D. DAVIDSON | 1820 EAST FIRST STREET SUITE 400 SANTA ANA, CA 92868 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $147 | $0 | $147 | 0.26% |
| JONATHAN S. SPETNER3 | 8630 DELMAR AVENUE SUITE 100 ST. LOUIS, MO 63124 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.03% |
| ALAN E. RUTLEDGE3 | 8630 DELMAR AVENUE SUITE 100 ST. LOUIS, MO 63124 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.03% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | WYSSTA INSURANCE COMPANY, INC. | $1K | $0 | $1K | 6.09% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $414 | $4K | 18.87% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $882 | $176 | $1K | 13.08% |
| JACK HEMB3 Filed as: JACK L. HEMB | 2801 COHO STREET SUITE 200 MADISON, WI 537134531 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 16.42% |
| C2 CENTRIC LLC3 | P.O. BOX 6824 GRAND RAPIDS, MI 49516 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $98 | $98 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 NONE | Claims processing; Contract Administrator Service code 12 | 11 SCOTT STREET SUITE 100 WAUSAU, WI 544034808 | $202K |
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 | 552 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 557 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | DELTA DENTAL OF WISCONSIN | 292 | $202K |
| Vision | WYSSTA INSURANCE COMPANY, INC. | 231 | $22K |
| Life insurance(4 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 432 | $83K |
| Short-term disability(2 contracts) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 172 | $56K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 0 | $7K |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 449 | $539K |
| Other(4 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 432 | $83K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 449 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.