| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS | 100 N CORPORATE DRIVE BROOKFIELD, WI 53045 | BLUE CROSS BLUE SHIELD OF WISCONSIN | $32K | — | $32K | 3.27% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SERVICES | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | DELTA DENTAL OF WISCONSIN | $11K | — | $11K | 11.32% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS INC | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $8K | — | $8K | 25.00% |
| JOHNSON INSURANCE SERVICES LLC3 | 1103 HUNTER DR MOUNT PLEASANT, WI 53406 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $319 | $319 | 1.06% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS INC | 100 N CORPORATE DR #100 BROOKFIELD, WI 53045 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
| JOHNSON INSURANCE SERVICES LLC3 | 1103 HUNTER DR MOUNT PLEASANT, WI 53406 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $199 | $199 | 1.18% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SERVICES | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | WYSSTA INSURANCE COMPANY INC | $939 | — | $939 | 8.08% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS INC | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| JOHNSON INSURANCE SERVICES LLC3 | 1103 HUNTER DR MOUNT PLEASANT, WI 53406 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $115 | $115 | 1.21% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS INC | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $654 | — | $654 | 15.00% |
| JOHNSON INSURANCE SERVICES LLC3 | 1103 HUNTER DR MOUNT PLEASANT, WI 53406 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $48 | $48 | 1.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $5K |
| DIVERSIFIED INSURANCE SOLUTIONS BROKER | Insurance agents and brokers Service code 22 | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | $57 |
| ASSOCIATED BENEFITS AND RISK CONSUL BROKER | Insurance agents and brokers Service code 22 | 711 EISENHOWER DR. KIMBERLY, WI 54136 | $10 |
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 | 139 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 8 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 153 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF WISCONSIN | 243 | $990K |
| Dental | DELTA DENTAL OF WISCONSIN | 115 | $101K |
| Vision | WYSSTA INSURANCE COMPANY INC | 85 | $12K |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 139 | $14K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 49 | $30K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 45 | $17K |
| Other(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF WISCONSIN | 243 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 243 | — |
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.