| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD #14A CHICAGO, IL 60604 | AETNA LIFE INSURANCE COMPANY | $52K | — | $52K | 14.08% |
| AON CONSULTING INC3 Filed as: AON HEWITT | 199 WATER STREET NEW YORK, NY 10038 | ACE AMERICAN INSURANCE COMPANY | $33K | — | $33K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF WISCONSIN EIN 39-0138065 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Other services; Contract Administrator Service code 12 | — | $1.3M |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | 5151 PFEIFFER ROAD CINCINNATI, OH 45242 | $1.1M |
| HEALTHAMERICA OF PA, INC EIN 62-1411933 NONE | Claims processing Service code 12 | — | $684K |
| MEDCO ASO NONE | Claims processing Service code 12 | N19 W24130 RIVERWOOD DR WAUKESHA, WI 53188 | $279K |
| AETNA BEHAVIORAL HEALTH, LLC PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 151 FARMINGTON AVE RSSA HARTFORD, CT 06156 | $100K |
| BMO HARRIS EIN 36-2085229 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $66K |
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 | 12,300 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 210 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 12,510 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA LIFE INSURANCE COMPANY | 64 | $370K |
| Dental(11 contracts, 3 carriers) | DELTA DENTAL OF WISCONSIN | 1,599 | $3.8M |
| Vision(3 contracts, 2 carriers) | EYEMED VISION CARE | 10,993 | $940K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 4,266 | $2.8M |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,243 | $797K |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 12,300 | $243K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 12,300 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.