| 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 STE 300 BROOKFIELD, WI 53005 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $31K | — | $31K | 3.00% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 5.34% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 400 N EXECUTIVE DR STE 300 BROOKFIELD, WI 53005 | HARTFORD LIFE AND ACCIDENT | $7K | — | $7K | 13.69% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SERV. W. | 801 S FIGUEROA STREET SUITE 800 LOS ANGELES, CA 90017 | HARTFORD LIFE AND ACCIDENT | — | $1K | $1K | 1.98% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | HARTFORD LIFE AND ACCIDENT | $707 | — | $707 | 1.31% |
| RICHARD F SAUTER3 | N3763 N RAPIDS RD JEFFERSON, WI 53549 | AFLAC | $3K | $9 | $3K | 12.01% |
| NICHOLAS LAACK-MILLER3 | 1100 GARDEN AVE STOUGHTON, WI 53589 | AFLAC | $544 | $2 | $546 | 2.27% |
| MICHAEL FRASIER3 | 258 CORPORATE DR STE 200 MADISON, WI 53714 | AFLAC | $391 | $2 | $393 | 1.63% |
| CASEY J HIGGINS3 | 9347 LIZARD ROCK TRL COLORADO SPRINGS, CO 80924 | AFLAC | $254 | — | $254 | 1.06% |
| EMILY N WAYNE3 | 1750 N CLYBOURN AVE, APT 202 CHICAGO, IL 60614 | AFLAC | $175 | — | $175 | 0.73% |
| FRANK J SAUTER3 | N1405 STATE ROAD 106 PALMYRA, WI 53156 | AFLAC | $159 | — | $159 | 0.66% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 400 N EXECUTIVE DR STE 200 BROOKFIELD, WI 53005 | AFLAC | $63 | — | $63 | 0.26% |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | AFLAC | $36 | — | $36 | 0.15% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST | 400 N EXECUTIVE DRIVE STE 300 BROOKFIELD, WI 53005 | WYSSTA INSURANCE COMPANY INC | $433 | — | $433 | 4.62% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | WYSSTA INSURANCE COMPANY INC | $43 | — | $43 | 0.46% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 93033 NETWORK PLACE CHICAGO, IL 60673 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $961 | — | $961 | 10.65% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $168 | — | $168 | 1.86% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 93033 NETWORK PLACE CHICAGO, IL 60673 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $306 | — | $306 | 12.13% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $72 | — | $72 | 2.85% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 93033 NETWORK PLACE CHICAGO, IL 60673 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $128 | — | $128 | 13.18% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $18 | — | $18 | 1.85% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 93033 NETWORK PLACE CHICAGO, IL 60673 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $28 | — | $28 | 13.21% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4 | — | $4 | 1.89% |
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 | 163 | 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) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 144 | $1.1M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF WISCONSIN | 100 | $89K |
| Vision | WYSSTA INSURANCE COMPANY INC | 84 | $9K |
| Life insurance(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 163 | $78K |
| Short-term disability(2 contracts, 2 carriers) | AFLAC | 27 | $25K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 163 | $54K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 144 | $1.0M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 163 | $78K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 163 | — |
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.