| 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 | — | $12K | 8.81% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 8.95% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $51 | $1K | 3.40% |
| 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 | $668 | — | $668 | 1.52% |
| SPETNER ASSOCIATES INC3 Filed as: SPETNER ASSOCIATES, INC. | 8630 DELMAR AVENUE SUITE 100 ST. LOUIS, MO 63124 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $399 | — | $399 | 0.91% |
| HAMBY, JAMES, WESLEY3 | 503 FORREST PARK COURT MADISON, AL 35758 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $142 | — | $142 | 0.32% |
| DAVIDSON JAMES DUNCAN3 Filed as: DAVIDSON, JAMES, DUNCAN | 1820 EAST 1ST STREET SUITE 400 SANTA ANA, CA 92868 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $22 | — | $22 | 0.05% |
| SPETNER ASSOCIATES INC3 Filed as: SPETNER, JONATHAN, SAMUEL | 8630 DELMAR BOULEVARD SUITE 100 ST. LOUIS, MO 63124 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.03% |
| RUTLEDGE, ALAN, E3 | 8630 DELMAR BOULEVARD SUITE 100 ST. LOUIS, MO 63124 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.03% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | WYSSTA INSURANCE COMPANY, INC. | $3K | — | $3K | 10.38% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 828 JOHN NOLEN DRIVE MADISON, WI 537131424 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $484 | $4K | 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 | $206 | $1K | 12.00% |
| JACK HEMB3 Filed as: JACK L. HEMB | 2801 COHO STREET SUITE 200 MADISON, WI 537134531 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 15.00% |
No Schedule C service providers reported on this filing.
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 | 600 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 603 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | DELTA DENTAL OF WISCONSIN | 286 | $197K |
| Vision | WYSSTA INSURANCE COMPANY, INC. | 278 | $32K |
| Life insurance(3 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 456 | $79K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 119 | $44K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 13 | $9K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 436 | $556K |
| Other(3 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 456 | $79K |
| 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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.