| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $14K | $9K | $23K | 4.97% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | VISION SERVICE PLAN | $2K | — | $2K | 4.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NETWORK HEALTH PLAN EIN 46-2966177 TPA | Other insurance wrap fees; Claims processing; Plan Administrator; Insurance services; Other insurance fees and expenses Service code 12 | — | $406K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 TPA | Contract Administrator Service code 13 | — | $16K |
| M3 INSURANCE SOLUTIONS INC INSURANCE AGENT | Insurance agents and brokers Service code 22 | PO BOX 10951 GREEN BAY, WI 543070951 | $165 |
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 | 454 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 458 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 241 | $40K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 452 | $463K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 452 | $463K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 452 | $463K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 452 | $463K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 452 | — |
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.