| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MOSSE & MOSSE INSURANCE ASSOCIATES3 | 50 SALEM ST, BLDG B LYNNFIELD, MA 01940 | SUN LIFE ASSURANCE COMPANY OF CANADA | $443K | — | $443K | 5.88% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP INSURANCE SERVICES, INC. | 1250 CAPITAL OF TEXAS HWY SOUTH SUITE 125 AUSTIN, TX 78746 | SUN LIFE ASSURANCE COMPANY OF CANADA | $43K | — | $43K | 0.57% |
| MOSSE & MOSSE INSURANCE ASSOCIATES3 | 50 SALEM ST, STE B LYNNFIELD, MA 01940 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $20K | $20K | 0.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON | LOCKBOX 9102 PO BOX 8500 PHILADELPHIA, PA 191789102 | UNITED HEALTHCARE INSURANCE COMPANY | $200K | — | $200K | 4.50% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | UNITED HEALTHCARE INSURANCE COMPANY | $102K | — | $102K | 2.30% |
| VISION SERVICE PLAN3 Filed as: VSP | PO BOX 997100 SACRAMENTO, CA 95899 | VISION SERVICE PLAN | — | $235K | $235K | 7.17% |
| MOSSE & MOSSE INSURANCE ASSOCIATES3 | 50 SALEM ST, BLDG B LYNNFIELD, MA 01940 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $53K | — | $53K | 5.00% |
| MOSSE & MOSSE INSURANCE ASSOCIATES3 | 50 SALEM ST, BLDG B LYNNFIELD, MA 01940 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $33K | — | $33K | 3.13% |
| MOSSE AND MOSSE ASSOCIATES, INC.3 | 50 SALEM STREET, BLDG B LYNNFIELD, MA 019400000 | FEDERAL INSURANCE COMPANY | $36K | — | $36K | 10.00% |
| MOSSE AND MOSSE ASSOCIATES, INC.3 | 50 SALEM STREET, BLDG B LYNNFIELD, MA 019400000 | FEDERAL INSURANCE COMPANY | $20K | — | $20K | 10.00% |
| DELTA DENTAL OF WISCONSIN3 | 1233 NORTH MAYFAIR ROAD STE 204 MILWAUKEE, WI 53226 | DELTA DENTAL OF WISCONSIN | — | $18K | $18K | — |
| DELTA DENTAL OF WISCONSIN3 | 1233 NORTH MAYFAIR ROAD STE 204 MILWAUKEE, WI 53226 | DELTA DENTAL OF WISCONSIN | — | $85K | $85K | — |
| DELTA DENTAL OF WISCONSIN3 | 1233 NORTH MAYFAIR ROAD STE 204 MILWAUKEE, WI 53226 | DELTA DENTAL OF WISCONSIN | — | $136K | $136K | — |
| DELTA DENTAL OF WISCONSIN3 | 1233 NORTH MAYFAIR ROAD STE 204 MILWAUKEE, WI 53226 | DELTA DENTAL OF WISCONSIN | — | $167K | $167K | — |
| DELTA DENTAL OF WISCONSIN3 | 1233 NORTH MAYFAIR RD STE 204 MILWAUKEE, WI 53226 | DELTA DENTAL OF WISCONSIN | — | $49K | $49K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF WI EIN 39-0138065 INSURER | Contract Administrator; Claims processing; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $7.4M |
| PRUDENTIAL INS CO OF AMERICA EIN 22-1211670 INSURER | Other services Service code 49 | — | $354K |
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESOR | Claims processing; Other services Service code 12 | — | $317K |
| STATE STREET BANK & TRUST EIN 04-1867445 TRUSTEE | Trustee (directed) Service code 25 | — | $10K |
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 | 9,408 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6,938 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 16,346 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 11,330 | $4.5M |
| Dental(5 contracts) | DELTA DENTAL OF WISCONSIN | 4,311 | $0 |
| Vision | VISION SERVICE PLAN | 9,306 | $3.3M |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 16,978 | $7.5M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 6,623 | $1.1M |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 6,623 | $1.1M |
| Other(2 contracts) | FEDERAL INSURANCE COMPANY | 8,435 | $558K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 16,978 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.