| 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 530056068 | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORATION | $7K | — | $7K | 2.01% |
| C M SMITH AGENCY, INC.3 Filed as: C. M. SMITH AGENCY INC. | 100 PEARL STREET 3RD FLOOR, WEST TOWER HARTFORD, CT 06103 | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORATION | $3K | — | $3K | 0.92% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SERVICES OF GA INC. | 1 GLENLAKE PARKWAY 11TH FLOOR ATLANTA, GA 303283496 | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORATION | — | $2K | $2K | 0.67% |
| C M SMITH AGENCY, INC.3 Filed as: C. M. SMITH AGENCY, INC. | 100 PEARL STREET 3RD FLOOR, WEST TOWER HARTFORD, CT 06103 | AETNA LIFE INSURANCE COMPANY | $10K | — | $10K | 6.67% |
| KATHI SOREY3 | 206 NORTH MAIN STREET SUITE 1 BRISTOL, CT 06010 | DELTA DENTAL OF NJ, INC. | $1K | — | $1K | 1.55% |
| C M SMITH AGENCY, INC.3 Filed as: C. M. SMITH AGENCY, INC. | 100 PEARL STREET 3RD FLOOR, WEST TOWER HARTFORD, CT 06103 | DELTA DENTAL OF WISCONSIN | $2K | — | $2K | 7.02% |
| C M SMITH AGENCY, INC.3 Filed as: C. M. SMITH AGENCY, INC. | 100 PEARL STREET 3RD FLOOR, WEST TOWER HARTFORD, CT 06103 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $685 | — | $685 | 6.52% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WI INC | 400 N EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 530056068 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $575 | — | $575 | 5.48% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA INC. | 16220 N SCOTTSDALE ROAD SCOTTSDALE, AZ 852541804 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $90 | $90 | 0.86% |
| C M SMITH AGENCY, INC.3 Filed as: C. M. SMITH AGENCY, INC. | 100 PEARL STREET 3RD FLOOR, WEST TOWER HARTFORD, CT 06103 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $533 | — | $533 | 7.29% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WI INC. | 400 N EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 530056068 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $368 | $66 | $434 | 5.94% |
| C M SMITH AGENCY, INC.3 Filed as: C. M. SMITH AGENCY, INC. | 100 PEARL STREET 3RD FLOOR, WEST TOWER HARTFORD, CT 06103 | WYSSTA INSURANCE COMPANY INC. | $77 | — | $77 | 4.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC. | 400 N EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | WYSSTA INSURANCE COMPANY INC. | $77 | — | $77 | 4.01% |
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 | 292 | 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) | 297 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORATION | 41 | $358K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF NJ, INC. | 119 | $127K |
| Vision | WYSSTA INSURANCE COMPANY INC. | 18 | $2K |
| Life insurance(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 247 | $162K |
| Short-term disability(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 247 | $165K |
| Other(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 247 | $162K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 247 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.