| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFIT ADVISORS INSURANCE AGENCY3 | 2123 13TH ST S LA CROSSE, WI 54601 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $62K | — | $62K | 0.72% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | DELTA DENTAL OF WISCONSIN | $45K | — | $45K | 8.89% |
| DEREK J DAHL3 | 221 JEFFERSON ST. JOHNSON CREEK, WI 53038 | STARMOUNT LIFE INSURANCE COMPANY | $13K | — | $13K | 3.87% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | STARMOUNT LIFE INSURANCE COMPANY | $11K | — | $11K | 3.02% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $11K | $18K | 6.57% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $10K | $16K | 7.11% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $6K | $17K | 12.75% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | WYSSTA INSURANCE COMPANY INC. | $6K | — | $6K | 8.06% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 13.13% |
| BRADLEY L WALKER4 | 1216 N 3RD AVE WASHINGTON, IA 52353 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | — | $1K | 6.00% |
| STUART W EVERSON4 | S8131 PRAIRIE RD BIROQUA, WI 54665 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | — | $1K | 5.50% |
| WILLIAM J WALKER4 | 3215 WAYLAND RD WAYLAND, IA 52654 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | — | $1K | 5.50% |
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 | 903 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 18 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 34 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 955 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 1,903 | $8.7M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF WISCONSIN | 650 | $859K |
| Vision(2 contracts, 2 carriers) | STARMOUNT LIFE INSURANCE COMPANY | 496 | $428K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 906 | $175K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 903 | $274K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 905 | $221K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 1,903 | $8.7M |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 906 | $198K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,903 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.