| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON US | P.O. BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $15K | $15K | 0.59% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON US | P.O. BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $48K | $6K | $54K | 5.61% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON US | P.O. BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 0.61% |
| HUB INTERNATIONAL MIDWEST LIMITED | 55 EAST JACKSON BLVD #14A CHICAGO, IL 60604 | AETNA LIFE INSURANCE COMPANY | — | $15K | $15K | 9.93% |
| 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: WILLIS TOWERS WATSON US | P.O. BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1 | $1 | 1.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF WISCONSIN EIN 39-0138065 NONE | Float revenue; Other services; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $2.3M |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | 5151 PFEIFFER ROAD CINCINNATI, OH 45242 | $1.4M |
| AETNA LIFE INSURANCE CO EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVE HARTFORD, CT 06156 | $471K |
| EXPRESS SCRIPTS ASO NONE | Claims processing Service code 12 | — | $291K |
| CIGNA GROUP INSURANCE NONE | Claims processing Service code 12 | PO BOX 20643 LEHIGH VALLEY, PA 180020643 | $214K |
| AETNA BEHAVIORAL HEALTH, LLC PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 151 FARMINGTON AVE RSSA HARTFORD, CT 06156 | $73K |
| BENEFIT ADVANTAGE NONE | Claims processing Service code 12 | 3431 COMMODITY LANE GREEN BAY, WI 53404 | $44K |
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 | 11,424 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 53 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 11,477 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 16 | $152K |
| Dental(12 contracts, 3 carriers) | DELTA DENTAL OF WISCONSIN | 1,494 | $2.9M |
| Vision(3 contracts, 2 carriers) | EYEMED VISION CARE | 9,725 | $602K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 4,082 | $2.5M |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,186 | $963K |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 11,424 | $302K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 11,424 | — |
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.