| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE | PO BOX 8950 MADISON, WI 53708 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 0.76% |
| M3 INSURANCE SOLUTIONS INC3 | PO BOX 8950 MADISON, WI 53708 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $3K | — | $3K | 6.19% |
| HNI RISK SERVICES3 Filed as: HNI RISK SERVICES INC | 16805 WEST CLEVELAND AVENUE PO BOX 510187 NEW BERLIN, WI 53151 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $2K | — | $2K | 3.81% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | P.O. BOX 8950 MADISON, WI 53708 | CARE-PLUS DENTAL PLANS, INC. | $834 | — | $834 | 4.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA HNI RISK | 5664 PRAIRIE CREEK DR. SE CALEDONIA, MI 49316 | CARE-PLUS DENTAL PLANS, INC. | $834 | — | $834 | 4.00% |
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 | 346 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 349 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CARE-PLUS DENTAL PLANS, INC. | 82 | $21K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | 249 | $50K |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 302 | $208K |
| Short-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 302 | $208K |
| Long-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 302 | $208K |
| Other | UNITEDHEALTHCARE INSURANCE COMPANY | 302 | $208K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 302 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.