| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST | CHURCH ST PO BOX 4557 NEW YORK, NY 10249 | DELTA DENTAL OF WISCONSIN | $2K | — | $2K | 7.11% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST | 3 COPLEY PLACE SUITE 300 BOSTON, MA 02116 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $772 | $359 | $1K | 4.40% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST | 3 COPLEY PLACE SUITE 300 BOSTON, MA 02116 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $145 | $48 | $193 | 4.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST | CHURCH ST PO BOX 4557 NEW YORK, NY 10249 | WYSSTA INSURANCE COMPANY INC | $181 | — | $181 | 8.80% |
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 | 0 | 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) | 1 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 31 | $28K |
| Vision(2 contracts, 2 carriers) | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 22 | $8K |
| Life insurance(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 0 | $31K |
| Short-term disability(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 0 | $31K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 0 | $26K |
| Other(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 0 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 31 | — |
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.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.