| 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 | $29K | $0 | $29K | 4.00% |
| 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 | Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $383K |
| AON EIN 22-2232264 BENEFITS MANAGER | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator Service code 13 | — | $270K |
| TOWERS WATSON INC. EIN 23-1159360 ACTUARIAL | Actuarial Service code 11 | — | $160K |
| WILLIS TOWERS WATSON ONEEXCHANGE EIN 26-0775680 CLAIMS ADMINISTRATION | Claims processing; Contract Administrator Service code 12 | — | $127K |
| NAVITUS HEALTH SOLUTIONS EIN 04-3608530 CLAIMS ADMINISTRATION | Contract Administrator; Claims processing Service code 12 | — | $47K |
| MOR STRATEGY GROUP EIN 20-0010448 CLAIMS ADMINISTRATION | Contract Administrator; Claims processing Service code 12 | — | $47K |
| COLEMAN & WILLIAMS, LTD. EIN 39-1658905 AUDIT | Accounting (including auditing) Service code 10 | 7127 N. GREEN BAY AVE. MILWAUKEE, WI 53209 | $32K |
| DELTA DENTAL EIN 39-6094742 CLAIMS ADMINISTRATION | Contract Administrator; Claims processing Service code 12 | — | $30K |
| NEPC EIN 26-1429809 CONSULTANT | Consulting (general) Service code 16 | — | $29K |
| WELLS FARGO BANK, NA EIN 94-1347393 TRUSTEE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $19K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3,225 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,225 | 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 | MINNESOTA LIFE INSURANCE COMPANY | 5,361 | $714K |
| Prescription drug | NAVITUS HEALTH SOLUTIONS | 0 | $0 |
| 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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.