| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN, INC. | 122 EAST COLLEGE AVE SUITE 201 APPLETON, WI 54911 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $80K | $10K | $89K | 11.21% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOIS, INC. | 233 S WACKER DR CHICAGO, IL 60606 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $61K | $7K | $68K | 11.08% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON | — | QBE INSURANCE | $81K | $0 | $81K | 15.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN, INC | P.O. BOX 1650 MILWAUKEE, WI 53201 | RELIASTAR LIFE INSURANCE COMPANY | $170K | $0 | $170K | 57.21% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN | 400 N EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | AETNA LIFE INSURANCE COMPANY | $10K | $0 | $10K | 9.06% |
| CONNECTEDHEALTH LLC3 | 2211 N ELSTON AVE SUITE 202 CHICAGO, IL 60614 | ALLSTATE BENEFITS | $6K | $0 | $6K | 31.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN | 1200 EAST TAFT STREET SAPULPA, OK 74066 | ALLSTATE BENEFITS | $3K | $0 | $3K | 15.52% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN, INC | 93033 NETWORK PLACE CHICAGO, IL 60673 | HYATT LEGAL PLANS | $456 | $128 | $584 | 10.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 INSURANCE CARRIER | Participant communication; Named fiduciary; Float revenue; Claims processing; Contract Administrator; Direct payment from the plan; Other services; Non-monetary compensation Service code 12 | — | $243K |
| BENEFIT EXTRAS, INC FSA ADMINISTRATOR | Plan Administrator; Claims processing Service code 12 | 10511 165TH STREET W LAKEVILLE, MN 55337 | $7K |
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 | 2,912 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,913 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | QBE INSURANCE | 431 | $670K |
| Dental(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,037 | $911K |
| Vision(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,037 | $911K |
| Life insurance(2 contracts, 2 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 662 | $909K |
| Short-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 662 | $612K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 662 | $612K |
| Other(3 contracts, 3 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 662 | $914K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,037 | — |
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.