| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN, INC. | 400 N EXECUTIVE DRIVE, SUITE 300 BROOKFIELD, WI 53005 | SUNLIFE ASSURANCE COMPANY OF CANADA | $37K | — | $37K | 13.80% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN, INC. | 122 E COLLEGE AVENUE APPLETON, WI 54911 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 4.97% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN, INC. | 400 N EXECUTIVE DRIVE, SUITE 300 BROOKFIELD, WI 53005 | THE EPIC LIFE INSURANCE COMPANY | $3K | — | $3K | 8.44% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN, INC. | 400 N EXECUTIVE DRIVE, SUITE 300 BROOKFIELD, WI 53005 | THE EPIC LIFE INSURANCE COMPANY | $4K | — | $4K | 14.19% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN, INC. | 93033 NETWORK PLACE, SUITE 300 CHICAGO, IL 60673 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $1K | — | $1K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CYPRESS BENEFIT ADMINISTRATORS, LLC EIN 39-1997579 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | 5560 W. GRANDE MARKET DRIVE APPLETON, WI 54913 | $37K |
| WILLIS OF WISCONSIN EIN 39-0765647 INSURANCE AGENT | Custodial (securities) Service code 19 | 131 S. DEARBORN, 6TH FLOOR CHICAGO, IL 60603 | $31K |
| JON D PLAMANN & ASSOCIATES, INC. EIN 39-1098844 INSURANCE AGENT | Custodial (securities) Service code 19 | 2650 W. LAWRENCE STREET APPLETON, WI 54914 | $14K |
| TRILOGY HEALTH INSURANCE EIN 20-5598514 OTHER | Other fees Service code 99 | 8000 WEST SARAH LANE, SUITE 310 BROOKFIELD, WI 53045 | $8K |
| AMERICAN HEALTH HOLDING EIN 31-1368946 OTHER | Other fees Service code 99 | 7400 WEST CAMPUS ROAD, F510 NEW ALBANY, OH 43054 | $7K |
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 | 206 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 207 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SUNLIFE ASSURANCE COMPANY OF CANADA | 132 | $271K |
| Dental | DELTA DENTAL OF WISCONSIN | 163 | $93K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | 188 | $11K |
| Life insurance | THE EPIC LIFE INSURANCE COMPANY | 218 | $34K |
| Long-term disability | THE EPIC LIFE INSURANCE COMPANY | 154 | $28K |
| Prescription drug | SUNLIFE ASSURANCE COMPANY OF CANADA | 132 | $271K |
| Other | MEDICAL EXCESS | 132 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 218 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.