| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WATSON | PO BOX 1650 MILWAUKEE, WI 53201 | DELTA DENTAL OF WISCONSIN | $15K | $0 | $15K | 0.31% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELEWARE INC | LOCKBOX #28852 PO BOX 28852 NEW YORK, NY 10087 | RELIANCE STANDARD LIFE INSURANCE COMPANY, LLC | $75K | $0 | $75K | 5.00% |
| RC INSURANCE SERVICES INC3 | SUITE 200 1320 WALNUT RIDGE DRIVE HARTFORD, WI 53209 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $32K | $0 | $32K | 4.00% |
| RC INSURANCE SERVICES INC3 | SUITE 200 1320 WALNUT RIDGE DRIVE HARTFORD, WI 53029 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $27K | $0 | $27K | 4.00% |
| RC INSURANCE SERVICES INC3 | SUITE 200 1320 WALNUT RIDGE DRIVE HARTFORD, WI 53029 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $32K | $0 | $32K | 5.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELEWARE INC | LOCKBOX #28852 PO BOX 28852 NEW YORK, NY 10087 | RELIANCE STANDARD LIFE INSURANCE COMPANY, LLC | $30K | $0 | $30K | 5.00% |
| RC INSURANCE SERVICES INC3 | SUITE 200 1320 WALNUT RIDGE DRIVE HARTFORD, WI 53029 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 4.00% |
| NATIONAL GROUP PROTECTION INC3 Filed as: NATIONAL GROUP PROTECTION | 1445 GREENBRIER PL CHARLOTTESVILLE, VA 22901 | CIGNA GROUP INSURANCE | $9K | $0 | $9K | 6.00% |
| NATIONAL GROUP PROTECTION INC3 Filed as: NATIONAL GROUP PROTECTION | 1445 GREENBRIER PL CHARLOTTESVILLE, VA 22901 | CIGNA GROUP INSURANCE | $7K | $0 | $7K | 6.00% |
| RC INSURANCE SERVICES INC3 | SUITE 200 1320 WALNUT RIDGE DRIVE HARTFORD, WI 53029 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 4.00% |
| RC INSURANCE SERVICES INC3 | SUITE 200 1320 WALNUT RIDGE DRIVE HARTFORD, WI 53029 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 4.00% |
| RC INSURANCE SERVICES INC3 | SUITE 200 1320 WALNUT RIDGE DRIVE HARTFORD, WI 53029 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELEWARE | LOCKBOX #28852 PO BOX 28852 NEW YORK, NY 10087 | RELIANCE STANDARD LIFE INSURANCE COMPANY, LLC | $28 | $0 | $28 | 10.65% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SVCS OF CA | PO BOX 101162 PASADENA, CA 91189 | HARTFORD LIFE AND ACCIDENT | — | $615 | $615 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $3.6M |
| MATRIX ABSENCE MANAGEMENT, INC EIN 77-0493584 NONE | Claims processing Service code 12 | — | $80K |
| WAGEWORKS EIN 94-3351864 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | 735 N WATER STREET SUITE 1500 MILWAUKEE, WI 53202 | $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 | 5,588 | 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) | 5,588 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 6 | $30K |
| Dental | DELTA DENTAL OF WISCONSIN | 4,652 | $4.9M |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 11,316 | $821K |
| Life insurance(7 contracts, 2 carriers) | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | 4,569 | $2.6M |
| Short-term disability(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY, LLC | 2,114 | $1.5M |
| Long-term disability(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY, LLC | 1,213 | $724K |
| Other(3 contracts, 3 carriers) | CIGNA GROUP INSURANCE | 5,348 | $225K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 11,316 | — |
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.