| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | P.O. BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $16K | $16K | 0.74% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | P.O. BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $40K | $4K | $45K | 5.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD #14A CHICAGO, IL 60604 | AETNA LIFE INSURANCE COMPANY | $36K | — | $36K | 10.07% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC | 199 WATER STREET NEW YORK, NY 10038 | ACE AMERICAN INSURANCE COMPANY | $14K | — | $14K | 7.14% |
| MERCER HEALTH AND BENEFITS, LLC Filed as: MERCER | 2405 GRAND BLVD KANSAS CITY, MO 64108 | ACE AMERICAN INSURANCE COMPANY | $127 | — | $127 | 0.06% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE | P.O. BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 0.67% |
| DELTA DENTAL OF WISCONSIN3 | — | DELTA DENTAL OF WISCONSIN | — | $896 | $896 | 1.99% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | P.O. BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $5 | $5 | 1.56% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF WISCONSIN EIN 39-0138065 NONE | Contract Administrator; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $1.4M |
| HEALTH AMERICA ASO EIN 62-1411933 NONE | Claims processing Service code 12 | 1238 MARKET PLACE WAUKESHA, WI 53189 | $525K |
| MEDCO ASO NONE | Claims processing Service code 12 | N19 W24130 RIVERWOOD DR WAUKESHA, WI 53188 | $283K |
| AETNA BEHAVIORAL HEALTH, LLC PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 151 FARMINGTON AVE RSSA HARTFORD, CT 06156 | $72K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | 5151 PFEIFFER ROAD CINCINNATI, OH 45242 | $55K |
| TOTAL ADMINISTRATIVE SERVICES CORP NONE | Other services Service code 49 | 2302 INTERNATIONAL LANE MADISON, WI 53704 | $14K |
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 | 10,500 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 247 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 10,747 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 49 | $355K |
| Dental(11 contracts, 3 carriers) | DELTA DENTAL OF WISCONSIN | 1,343 | $3.0M |
| Vision(3 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 8,235 | $739K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,339 | $2.1M |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,647 | $807K |
| Other(3 contracts, 3 carriers) | ACE AMERICAN INSURANCE COMPANY | 10,500 | $401K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,500 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.