| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN, INC. | 400 N EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORATION | $13K | — | $13K | 2.45% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF GEORGI | 1 GLEN LAKE PARKWAY 11TH FLOOR ATLANTA, GA 30328 | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORATION | $0 | $3K | $3K | 0.46% |
| C M SMITH AGENCY, INC.3 Filed as: C. M. SMITH AGENCY, INC. | 100 PEARL STREET, THIRD FLOOR, WEST HARTFORD, CT 06103 | AETNA LIFE INSURANCE COMPANY | $6K | — | $6K | 4.41% |
| KATHI SOREY3 Filed as: KATHI SOREY ASSOCIATES | 206 NORTH MAIN STREET SUITE 1 BRISTOL, CT 06010 | DELTA DENTAL OF NJ, INC. | $2K | — | $2K | 2.10% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN, INC. | 400 N EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | DELTA DENTAL OF WISCONSIN | $3K | — | $3K | 7.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WI INC. | 400 N EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 12.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA | 16220 N SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $223 | $223 | 1.85% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WI INC. | 400 N EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 12.21% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA | 16220 N SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $167 | $167 | 1.89% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN | 400 N EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | WYSSTA INSURANCE COMPANY INC. | $138 | — | $138 | 8.01% |
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 | 280 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 285 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORATION | 44 | $551K |
| Dental(3 contracts, 3 carriers) | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORATION | 175 | $679K |
| Vision | WYSSTA INSURANCE COMPANY INC. | 17 | $2K |
| Life insurance(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 234 | $138K |
| Short-term disability(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 234 | $142K |
| Other(3 contracts, 3 carriers) | AETNA LIFE INSURANCE COMPANY | 283 | $143K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 283 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.