| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 740 REGENT ST STE 400 MADISON, WI 53715 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $23K | — | $23K | 1.34% |
| SJH AGENCY INC3 | 9B THE PINES CT ST LOUIS, MO 63141 | HEALTHY ALLIANCE LIFE INSURANCE COMPANY | $2K | — | $2K | 2.85% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN JOHNSON INSURANCE INC | 740 REGENT STREET #400 MADISON, WI 53715 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | — | $7K | 11.28% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 53715 | WYSSTA INSURANCE COMPANY INC | $483 | — | $483 | 8.03% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATO | Contract Administrator Service code 13 | — | $6K |
| INGENIUM PRIME INC INSURANCE AGENT OR BROKE | Insurance agents and brokers Service code 22 | PO BOX 259408 MADISON, WI 537159408 | $864 |
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 | 126 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 206 | $1.8M |
| Vision | WYSSTA INSURANCE COMPANY INC | 68 | $6K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 187 | $58K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 187 | $58K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 206 | $1.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 206 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.