| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | BLUE CROSS BLUE SHIELD OF WISCONSIN | $14K | $4K | $18K | 1.87% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INSURANCE SER | 800 MAIN STREET DUBUQUE, IA 52001 | BLUE CROSS BLUE SHIELD OF WISCONSIN | $6K | — | $6K | 0.63% |
| COTTINGHAM & BUTLER3 | 300 SECURITY BUILDING DUBUQUE, IA 52001 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 8.20% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DR MADISON, WI 53713 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 10.65% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SVCS INC | 800 MAIN ST DUBUQUE, IA 52001 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 4.49% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $523 | $12 | $535 | 5.19% |
| GETTYSBURG BENEFITS ADMINISTRATORS3 | DBA BENAW GETTYSBURGE BENEFITS ADMI 777 BALTIMORE ST STE 97 GETTYSBURG, PA 17325 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $382 | — | $382 | 3.71% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER | 800 MAIN ST DUBUQUE, IA 52001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $137 | — | $137 | 1.33% |
| GEBO, MICKEY, JOHN3 | 480 LOUD ROAD FAIRPORT, NY 14450 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $76 | — | $76 | 0.74% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DR MADISON, WI 53713 | WYSSTA INSURANCE COMPANY INC | $731 | — | $731 | 8.00% |
| COTTINGHAM & BUTLER3 | 300 SECURITY BUILDING DUBUQUE, IA 52001 | WYSSTA INSURANCE COMPANY INC | — | — | $0 | 0.00% |
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 | 93 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 94 | 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 | 173 | $1.2M |
| Dental | DELTA DENTAL OF WISCONSIN | 41 | $55K |
| Vision | WYSSTA INSURANCE COMPANY INC | 68 | $9K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 102 | $46K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 102 | $46K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 102 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.