| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | 233 S WACKER DRIVE SUITE 2000 CHICAGO, IL 60606 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $66K | $3K | $69K | 4.06% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 233 SOUTH WACKER DRIVE SUITE 2000 CHICAGO, IL 60606 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 2.30% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $32 | $32 | 0.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | 425 NORTH MARTINGALE ROAD SUITE 1100 SCHAUMBURG, IL 60173 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 5.83% |
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 | 144 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 157 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 171 | $1.7M |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 104 | $103K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 104 | $103K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 144 | $145K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 144 | $145K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 144 | $145K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ILLINOIS | 171 | $1.7M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 144 | $248K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 171 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.