| 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 | COMMUNITY INSURANCE COMPANY | $33K | $3K | $36K | 3.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SERV | 801 SOUTH FIGUEROA STREET STE 800 LOS ANGELES, CA 90017 | COMMUNITY INSURANCE COMPANY | — | $200 | $200 | 0.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SERV | 801 SOUTH FIGUEROA STREET STE 800 LOS ANGELES, CA 90017 | ANTHEM LIFE INSURANCE COMPANY (G1400) | — | $1K | $1K | 1.44% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 400 NORTH EXECUTIVE DRIVE SUITE 30 BROOKFIELD, WI 53005 | ANTHEM LIFE INSURANCE COMPANY (G1400) | $914 | — | $914 | 1.04% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 93245 NETWORK PLACE CHICAGO, IL 606730001 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | — | $4K | 4.62% |
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 | 180 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 182 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 242 | $1.2M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 256 | $86K |
| Vision | COMMUNITY INSURANCE COMPANY | 242 | $1.2M |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY (G1400) | 180 | $88K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY (G1400) | 180 | $88K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY (G1400) | 180 | $88K |
| Other | ANTHEM LIFE INSURANCE COMPANY (G1400) | 180 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 256 | — |
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.