| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC. | 600 HIGHWAY 169 S, SUITE 1200 ST LOUIS PARK, MN 55426 | MINNESOTA LIFE INSURANCE COMPANY | $80K | $0 | $80K | 4.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO | 150 N. MICHIGAN AVE. CHICAGO, IL 60601 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $29K | $0 | $29K | 3.00% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: WELLS FARGO INS. SERVICES USA INC | PO BOX 203066 DALLAS, TX 753203066 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $0 | $0 | $0 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC. | 600 HIGHWAY 169 S, SUITE 1200 ST LOUIS PARK, MN 55426 | MINNESOTA LIFE INSURANCE COMPANY | $29K | $0 | $29K | 4.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC. | 600 HIGHWAY 169 S, SUITE 1200 ST LOUIS PARK, MN 55426 | MINNESOTA LIFE INSURANCE COMPANY | $7K | $0 | $7K | 4.00% |
| WELLS FARGO INSURANCE SERVICES Filed as: WELLS FARGO INSURANCE SER | PO BOX 201503, GEORGIA LOCKBOX DALLAS, TX 75320 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $0 | $1K | 15.01% |
| REUBEN WARNER ASSOCIATES, INC. Filed as: REUBEN WARNER ASSOCIATES | 1655 RICHMOND AVE STATEN ISLAND, NY 10314 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $951 | $951 | 10.00% |
| N/A | — | BLUE CROSS BLUE SHIELD OF WISCONSIN | $0 | $0 | $0 | — |
| N/A | — | NAVITUS HEALTH SOLUTIONS | $0 | $0 | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS BLUE SHIELD EIN 39-0138065 CLAIMS ADMINISTRATION | Claims processing; Other services; Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $1.9M |
| AON EIN 22-2232264 BENEFITS MANAGER | Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | — | $481K |
| MOR STRATEGY GROUP EIN 20-0010448 CLAIMS ADMINISTRATION | Contract Administrator; Claims processing Service code 12 | — | $297K |
| NAVITUS HEALTH SOLUTIONS EIN 04-3608530 CLAIMS ADMINISTRATION | Contract Administrator; Claims processing Service code 12 | — | $219K |
| TOWERS WATSON INC. EIN 23-1159360 ACTUARIAL | Actuarial Service code 11 | — | $154K |
| DELTA DENTAL EIN 39-6094742 CLAIMS ADMINISTRATION | Claims processing; Contract Administrator Service code 12 | — | $147K |
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 | 3,473 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 20 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,493 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF WISCONSIN | 0 | $0 |
| Vision | BLUE CROSS BLUE SHIELD OF WISCONSIN | 0 | $0 |
| Life insurance(3 contracts) | MINNESOTA LIFE INSURANCE COMPANY | 5,361 | $2.9M |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 4,113 | $979K |
| Prescription drug | NAVITUS HEALTH SOLUTIONS | 0 | $0 |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,361 | — |
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.