| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAUSMANN-JOHNSON INSURANCE INC3 | 700 REGENT STREET MADISON, WI 53725 | GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN | $26K | — | $26K | 1.91% |
| HAUSMAN JOHNSON INSURANCE INC3 Filed as: HAUSMAN JOHNSON INSURANCE | 700 REGENT STREET MADISON, WI 53715 | COMPANION LIFE INSURANCE | $8K | — | $8K | 12.71% |
| TURNKEY BENEFIT INSURANCE SERVICES3 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | COMPANION LIFE INSURANCE | $4K | — | $4K | 5.51% |
| HAUSMANN-JOHNSON INSURANCE INC3 | PO BOX 259408 MADISON, WI 53715 | WYSSTA INSURANCE COMPANY INC | $3K | — | $3K | 7.46% |
| HAUSMANN-JOHNSON INSURANCE INC3 | PO BOX 259408 MADISON, WI 53725 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $148 | $2K | 10.70% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC. EIN 35-1450364 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | 8330 ALLSION POINTE TRAIL INDIANAPOLIS, IN 46250 | $57K |
| HAUSMANN JOHNSON INSURANCE EIN 39-1090217 BROKER | Insurance agents and brokers Service code 22 | 700 REGENT STREET MADISON, WI 53715 | $22K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATO | Contract Administrator Service code 13 | 1233 N MAYFAIR RD STE 204 MILWAUKEE, WI 53226 | $16K |
| AMERICAN HEALTH DATE INSTITUTE EIN 35-2048379 UTILIZATION REVIEWER | Other services Service code 49 | 8330 ALLSION POINTE TRAIL INDIANAPOLIS, IN 46250 | $13K |
| TURNKEY BENEFIT INSURANCE SERVICES EIN 35-1814177 HOUSE BROKER | Other commissions; Insurance agents and brokers Service code 22 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | $9K |
| RGI, LLC EIN 32-0176370 HOLDS CONTRACT | Contract Administrator Service code 13 | 8330 ALLSION POINTE TRAIL INDIANAPOLIS, IN 46250 | $5K |
| MULTIPLAN EIN 35-2048379 PPO CARRIER | Other services Service code 49 | 115 5TH AVENUE 7TH FLOOR NEW YORK, NY 10003 | $5K |
| HAUSMANN JOHNSON INSURANCE INC EIN 39-1090217 INSURANCE AGENT OR BROKE | Insurance agents and brokers Service code 22 | PO BOX 259408 MADISON, WI 537259408 | $226 |
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 | 464 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 467 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN | 318 | $1.4M |
| Vision | WYSSTA INSURANCE COMPANY INC | 235 | $41K |
| Life insurance(2 contracts, 2 carriers) | COMPANION LIFE INSURANCE | 224 | $81K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 170 | $16K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 170 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 318 | — |
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.