| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN | 400 N EXECUTIVE DR STE 400 BROOKFIELD, WI 53005 | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORATION | — | $15K | $15K | 2.25% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE SOLUTIONS | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORATION | — | $5K | $5K | 0.75% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SERVICES OF GEORGIA | 1 GLENLAKE PKWY 11TH FLOOR ATLANTA, GA 30328 | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORATION | — | $5K | $5K | 0.70% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN | 400 N EXECUTIVE DR STE 300 BROOKFIELD, WI 53005 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $1K | $1K | 7.61% |
| DIVERSIFIED INSURANCE3 Filed as: DIVERSIFIED | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $422 | $422 | 2.39% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA | 16220 N SCOTTSDALE RD STE 600 SCOTTSDALE, AZ 85254 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $253 | $253 | 1.43% |
| WILLIS TOWERS WATSON US LLC1 Filed as: WILLIS OF WISCONSIN | 93033 NETWORK PLACE STE 300 CHICAGO, IL 60673 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | — | $639 | $639 | 8.22% |
| DIVERSIFIED INSURANCE GROUP1 Filed as: DIVERSIFIED INSURANCE SOLUTIONS | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | — | $126 | $126 | 1.62% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 2801 HOOVER RD STEVENS POINT, WI 54481 | $4K |
| DIVERSIFIED INSURANCE SOLUTIONS INSURANCE AGENT | Custodial (securities) Service code 19 | 100 N CORPORATE DR STE 100 BROOKFIELD, WI 53045 | $1K |
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 | 100 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CORPORATION | 86 | $669K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | 71 | $8K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 100 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 100 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.