| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAUSMANN GROUP INC3 Filed as: HAUSMANN GROUP INC. | 700 REGENT ST - STE 400 MADISON, WI 53715 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $16K | — | $16K | 3.05% |
| HAUSMANN GROUP INC3 Filed as: HAUSMANN GROUP | PO BOX 259408 MADISON, WI 53715 | DELTA DENTAL OF WISCONSIN | $3K | — | $3K | 8.99% |
| HAUSMANN GROUP INC3 Filed as: HAUSMANN GROUP INC. | 740 REGENT ST - SUITE 400 MADISON, WI 53715 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 8.07% |
| INGENIUM PRIME INC3 Filed as: INGENIUM PRIME INC. | PO BOX 259408 MADISON, WI 53715 | WYSSTA INSURANCE CMPANY INC. | $347 | — | $347 | 7.99% |
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 | 95 | 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) | 95 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 81 | $532K |
| Dental | DELTA DENTAL OF WISCONSIN | 62 | $34K |
| Vision | WYSSTA INSURANCE CMPANY INC. | 39 | $4K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 98 | $33K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 98 | $33K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 81 | $532K |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 98 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 98 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.