| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 400 NORTH EXECUTIVE DRIVE SUITE 30 BROOKFIELD, WI 53005 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $32K | — | $32K | 9.10% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 300 S GRAND AVE STE 2000 LOS ANGELES, CA 90071 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | — | $4K | $4K | 1.14% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST | 400 NORTH EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $3K | — | $3K | 5.16% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST | 122 EAST COLLEGE AVENUE SUITE 201 APPLETON, WI 54911 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $16K | — | $16K | 39.37% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | 35371 NETWORK PLACE CHICAGO, IL 60673 | ARAG INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST | 400 NORTH EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $936 | — | $936 | 6.51% |
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 | 1,367 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,367 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 1,082 | $355K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 1,082 | $355K |
| Life insurance | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 1,218 | $64K |
| Short-term disability | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 1,218 | $120K |
| Long-term disability | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 1,218 | $66K |
| Other(4 contracts, 4 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,450 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,450 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.