| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 400 N EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | QBE INSURANCE | — | $33K | $33K | 7.49% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | STANDARD INSURANCE COMPANY | $15K | — | $15K | 4.54% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 0.46% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | STANDARD INSURANCE COMPANY | $9K | — | $9K | 4.55% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | STANDARD INSURANCE COMPANY | $968 | — | $968 | 0.46% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $384K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIM ADMINISTRATION | Direct payment from the plan; Contract Administrator; Claims processing; Named fiduciary; Float revenue; Non-monetary compensation; Other services; Participant communication Service code 12 | — | $35K |
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 | 757 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 757 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 464 | $96K |
| Life insurance(2 contracts) | STANDARD INSURANCE COMPANY | 769 | $362K |
| Long-term disability | STANDARD INSURANCE COMPANY | 599 | $209K |
| Stop-loss / reinsurancereinsurance | QBE INSURANCE | 538 | $434K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 769 | — |
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.