| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAUSMANN GROUP INC3 | 740 REGENT ST 4TH FLOOR MADISON, WI 53715 | BLUE CROSS BLUE SHIELD OF WISCONSIN | $37K | — | $37K | 2.46% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE, INC. | 700 REGENT STREET MADISON, WI 53715 | AXIS INSURANCE COMPANY | $40K | — | $40K | 9.86% |
| HAUSMANN-JOHNSON INSURANCE INC3 | 740 REGENT STREET SUITE 400 MADISON, WI 53715 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $1K | $8K | 9.36% |
| INGENIUM PRIME INC3 | PO BOX 259408 MADISON, WI 53715 | WYSSTA INSURANCE COMPANY INC | $4K | — | $4K | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $16K |
| UNUM LIFE INSURANCE COMPANY EIN 01-0278678 ADMINISTRATIVE SERVICE | Claims processing; Contract Administrator Service code 12 | — | $7K |
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | — | $6K |
| DIVERSIFIED BENEFIT SERVICES, INC. EIN 46-3804534 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $6K |
| HAUSMANN-JOHNSON INSURANCE, INC. EIN 39-1090217 BROKER | Insurance agents and brokers Service code 22 | 740 REGENT STREET 4TH FLOOR PO BOX 259408 MADISON, WI 53725 | $411 |
| BARRY RICHTER INGENIUM PRIME INC BROKER | Insurance agents and brokers Service code 22 | PO BOX 259408 MADISON, WI 53715 | $177 |
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 | 420 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 28 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 449 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF WISCONSIN | 287 | $1.9M |
| Vision | WYSSTA INSURANCE COMPANY INC | 272 | $44K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 176 | $87K |
| Short-term disability | AXIS INSURANCE COMPANY | 176 | $402K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 176 | $87K |
| Prescription drug | AXIS INSURANCE COMPANY | 176 | $402K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 176 | $87K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 287 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.