| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 740 REGENT ST SUITE 400 MADISON, WI 53715 | UNUM INSURANCE COMPANY | — | $2K | $2K | 2.51% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 740 REGENT ST SUITE 400 MADISON, WI 53715 | UNUM INSURANCE COMPANY | — | $405 | $405 | 2.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NATIONAL HEALTH INSURANCE COMPANY PLAN ADMIN | Plan Administrator Service code 14 | P.O. BOX 619999 DALLAS, TX 75261 | $82K |
| ALLSTATE BENEFITS PLAN ADMIN | Plan Administrator Service code 14 | 1515 NORTH RIVERCENTER DRIVE SUITE #135 MILWAUKEE, WI 53212 | $9K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATO | Contract Administrator Service code 13 | — | $6K |
| MICHAEL JOHNSON BROKER | Insurance agents and brokers Service code 22 | PO BOX 259408 MADISON, WI 53715 | $121 |
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 | 109 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 179 | $784K |
| Vision | VISION SERVICE PLAN | 75 | $9K |
| Life insurance(2 contracts) | UNUM INSURANCE COMPANY | 118 | $105K |
| Short-term disability | UNUM INSURANCE COMPANY | 118 | $89K |
| Long-term disability | UNUM INSURANCE COMPANY | 118 | $89K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 179 | $784K |
| Other(2 contracts) | UNUM INSURANCE COMPANY | 118 | $105K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 179 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.