| 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 | $13K | $0 | $13K | 9.29% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $91 | $2K | 4.24% |
| EOI SERVICE COMPANY INC3 Filed as: EOI SERVICE COMPANY, INC. | 1820 EAST 1ST STREET SUITE 400 SANTA ANA, CA 92705 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | -$49 | $1K | 2.66% |
| SPETNER ASSOCIATES INC3 Filed as: SPETNER ASSOCIATES, INC. | 8630 DELMAR AVENUE SUITE 100 ST. LOUIS, MO 63124 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $504 | $0 | $504 | 0.90% |
| HAMBY, JAMES, WESLEY3 | 503 FORREST PARK COURT MADISON, AL 35758 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $176 | $0 | $176 | 0.31% |
| DAVIDSON JAMES DUNCAN3 Filed as: DAVIDSON, JAMES, DUNCAN | 1820 EAST 1ST STREET SUITE 400 SANTA ANA, CA 92868 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $45 | $0 | $45 | 0.08% |
| SPETNER ASSOCIATES INC3 Filed as: SPETNER, JONATHAN, SAMUEL | 8630 DELMAR BOULEVARD SUITE 100 ST. LOUIS, MO 63124 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.02% |
| RUTLEDGE, ALAN, E3 | 8630 DELMAR BOULEVARD 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 | DELTA DENTAL OF WISCONSIN | $5K | $0 | $5K | 9.52% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | WYSSTA INSURANCE COMPANY, INC. | $2K | $0 | $2K | 8.34% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $393 | $3K | 17.00% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $202 | $1K | 12.11% |
| JACK HEMB3 Filed as: JACK L. HEMB | 2801 COHO STREET SUITE 200 MADISON, WI 537134531 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 15.04% |
| C2 CENTRIC LLC3 Filed as: C2 CENTRIC, LLC | P.O. BOX 6824 GRAND RAPIDS, MI 49516 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $11 | $11 | — |
| 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 | $206K |
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 | 523 | 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) | 528 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | DELTA DENTAL OF WISCONSIN | 292 | $195K |
| Vision | WYSSTA INSURANCE COMPANY, INC. | 254 | $27K |
| Life insurance(4 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 456 | $86K |
| Short-term disability(2 contracts) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 141 | $56K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 14 | $9K |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 423 | $543K |
| Other(4 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 456 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 456 | — |
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."
No prospect flags tripped on this filing.