| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS INC | 100 NORTH CORPORATE DRIVE SUITE 100 BROOKFIELD, WI 53045 | SUN LIFE ASSURANCE COMPANY OF CANADA | $56K | — | $56K | 15.00% |
| UNITED BENEFITS ADVISORS INC3 | 280 EAST 96TH STREET SUITE 250 INDIANAPOLIS, IN 46240 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | — | $8K | 2.08% |
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS COALITION SERVICES LLC | 7632 SOUTHWEST DURHAM ROAD SUITE 115 TIGARD, OR 97224 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 0.42% |
| UNITED BENEFITS ADVISORS INC3 | 10 WUNSHINE LANE RED LION, PA 17356 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $695 | $695 | 0.19% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SERVICES | 100 NORTH CORPORATE DRIVE SUITE 100 BROOKFIELD, WI 53045 | DELTA DENTAL OF WISCONSIN | $7K | — | $7K | 4.88% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS | 100 NORTH CORPORATE DRIVE SUITE 100 BROOKFIELD, WI 53045 | HUMANA HEALTH PLAN, INC | $3K | $1K | $4K | 3.69% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SERVICES INC. | 100 NORTH CORPORATE DRIVE SUITE 100 BROOKFIELD, WI 53045 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 13.05% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SERVICES INC | 100 NORTH CORPORATE DRIVE SUITE 100 BROOKFIELD, WI 53045 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS INC | 100 NORTH CORPORATE DRIVE SUITE 100 BROOKFIELD, WI 53045 | HUMANA INSURANCE COMPANY | $2K | $140 | $2K | 10.70% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SERVICES INC | 100 NORTH CORPORATE DRIVE SUITE 100 BROOKFIELD, WI 53045 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SERVICES INC. | 100 NORTH CORPORATE DRIVE SUITE 100 BROOKFIELD, WI 53045 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 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 | 235 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 235 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 223 | $139K |
| Vision | HUMANA INSURANCE COMPANY | 130 | $20K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 245 | $64K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 245 | $30K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 72 | $14K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 225 | $483K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 245 | $84K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 245 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.