| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WI INC | PO BOX 1650 MILWAUKEE, WI 532011650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WI INC | PO BOX 1650 MILWAUKEE, WI 532011650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 15.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WI INC | PO BOX 1650 MILWAUKEE, WI 532011650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 15.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WI INC | PO BOX 1650 MILWAUKEE, WI 532011650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 400 N EXECUTIVE DR STE 300 BROOKFIELD, WI 530056068 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | $3K | — | $3K | 9.95% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWER WATSON MIDWEST INC | 400 N EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $649 | — | $649 | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON | 400 N EXECUTIVE DR STE 300 BROOKFIELD, WI 53005 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $388 | $11 | $399 | 8.47% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWER WATSON MIDWEST INC | 400 N EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $360 | — | $360 | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON | 400 N EXECUTIVE DR STE 300 BROOKFIELD, WI 53005 | PROVIDENT LIFE AND ACCIDENT INSURANCE | $19 | $1 | $20 | 4.74% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX EIN 33-0441200 PHARMACY BENEFIT MGMT | Direct payment from the plan; Claims processing; Other fees; Float revenue Service code 12 | — | $497K |
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $154K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 TPA-DENTAL | Contract Administrator Service code 13 | — | $10K |
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 | 208 | 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) | 208 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | 141 | $27K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 208 | $74K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $81K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 208 | $32K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 185 | $593K |
| Other(6 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 208 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 208 | — |
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.