| 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 | — | $17K | $17K | 0.90% |
| 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 | $37K | $7K | $44K | 5.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD #14A CHICAGO, IL 60604 | AETNA LIFE INSURANCE COMPANY | $22K | — | $22K | 11.46% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE | P.O. BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 0.88% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER | 2405 GRAND BLVD, SUITE 900 KANSAS CITY, MO 64108 | ACE AMERICAN INSURANCE COMPANY | — | — | $0 | 0.00% |
| MERCER HEALTH AND BENEFITS, LLC Filed as: MERCER | 2405 GRAND BLVD KANSAS CITY, MO 64108 | ACE AMERICAN INSURANCE COMPANY | — | — | $0 | 0.00% |
| 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 | — | $3 | $3 | 3.53% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF WISCONSIN EIN 39-0138065 NONE | Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $1.3M |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | 5151 PFEIFFER ROAD CINCINNATI, OH 45242 | $996K |
| AETNA LIFE INSURANCE CO EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVE HARTFORD, CT 06156 | $460K |
| EXPRESS SCRIPTS ASO NONE | Claims processing Service code 12 | — | $257K |
| AETNA BEHAVIORAL HEALTH, LLC PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 151 FARMINGTON AVE RSSA HARTFORD, CT 06156 | $69K |
| BENEFIT ADVANTAGE NONE | Claims processing Service code 12 | 3431 COMMODITY LANE GREEN BAY, WI 53404 | $62K |
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 | 11,674 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 91 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 11,765 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 31 | $191K |
| Dental(11 contracts, 3 carriers) | DELTA DENTAL OF WISCONSIN | 1,477 | $2.7M |
| Vision(3 contracts, 2 carriers) | EYEMED VISION CARE | 9,285 | $598K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,780 | $1.9M |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,933 | $739K |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 11,674 | $317K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 11,674 | — |
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."
No prospect flags tripped on this filing.