| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BARRY RICHTER3 | 700 REGENT ST PO BOX 259408 MADISON, WI 53725 | WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION | $41K | — | $41K | 3.00% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN JOHNSON INSURANCE | 700 REGENT STREET MADISON, WI 53715 | COMPANION LIFE INSURANCE | $26K | — | $26K | 10.43% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 53715 | WYSSTA INSURANCE COMPANY INC | $5K | — | $5K | 8.00% |
| HAUSMANN-JOHNSON INSURANCE INC3 | PO BOX 259408 MADISON, WI 53725 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $486 | $7K | 11.62% |
| HAUSMAN JOHNSON INSURANCE INC3 Filed as: HAUSMAN JOHNSON INSURANCE | PO BOX 259408 MADISON, WI 53725 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $218 | $5K | 15.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATO | Contract Administrator Service code 13 | — | $22K |
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | — | $14K |
| UNUM LIFE INSURANCE COMPANY EIN 01-0278678 ADMINISTRATIVE SERVICE | Contract Administrator; Claims processing Service code 12 | — | $6K |
| HAUSMANN JOHNSON INSURANCE EIN 39-1090217 BROKER | Insurance agents and brokers Service code 22 | 700 REGENT STREET MADISON, WI 53715 | $766 |
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 | 498 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 502 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION | 331 | $1.6M |
| Vision | WYSSTA INSURANCE COMPANY INC | 330 | $61K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 200 | $88K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 200 | $59K |
| Other(3 contracts, 2 carriers) | COMPANION LIFE INSURANCE | 215 | $339K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 331 | — |
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."
No prospect flags tripped on this filing.