| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 400 N EXECUTIVE DR STE 400 BROOKFIELD, WI 530056029 | UNITEDHEALTHCARE INSURANCE COMPANY | $18K | — | $18K | 1.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1411 OPUS PL STE 450 DOWNERS GROVE, IL 605151423 | UNITEDHEALTHCARE INSURANCE COMPANY | $7K | — | $7K | 0.59% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS INC. | 828 JOHN NOLEN DR MADISON, WI 53713 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $3K | — | $3K | 1.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 251 PROGRESS WAY STE 300 WAUNAKEE, WI 53597 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $756 | — | $756 | 0.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 93033 NETWORK PLACE CHICAGO, IL 606731930 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $211 | $2K | 10.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 15162 COLLECTIONS CENTER DRIVE CHICAGO, IL 60693 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 5.08% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 93033 NETWORK PLACE CHICAGO, IL 606731930 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $913 | $89 | $1K | 10.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 15162 COLLECTIONS CENTER DRIVE CHICAGO, IL 60693 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $465 | — | $465 | 5.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $6K |
| HUB INTERNATIONAL MIDWEST LTD BROKER | Insurance agents and brokers Service code 22 | 55 E JACKSON BLVD CHICAGO, IL 60604 | $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 | 114 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 182 | $1.2M |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 182 | $1.2M |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 114 | $9K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 114 | $22K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 36 | $276K |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 114 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 182 | — |
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."
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.