| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAUSMANN-JOHNSON INSURANCE INC3 | PO BOX 259408 MADISON, WI 537259408 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $35K | $35K | 3.45% |
| INGENIUM PRIME INC3 | 700 REGENT ST MADISON, WI 53715 | UNITEDHEALTHCARE INSURANCE COMPANY | $7K | — | $7K | 0.72% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 53715 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 9.01% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 53715 | WYSSTA INSURANCE COMPANY INC | $1K | — | $1K | 7.79% |
| BENEFIT SERVICES GROUP, INC.3 Filed as: BENEFIT SERVICES GROUP INC | PO BOX 6762 CAROL STREAM, IL 60197 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | — | $1K | 13.89% |
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 | 134 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 146 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 117 | $1.0M |
| Dental | DELTA DENTAL OF WISCONSIN | 104 | $60K |
| Vision | WYSSTA INSURANCE COMPANY INC | 120 | $18K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 255 | $9K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 255 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 255 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.