| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC. | 400 N EXECUTIVE DR STE 300 BROOKFIELD, WI 53005 | SUN LIFE ASSURANCE COMPANY OF CANADA | $35K | — | $35K | 9.36% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $6K | $6K | 1.62% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 400 N EXECUTIVE DR STE 300 BROOKFIELD, WI 53005 | SUN LIFE ASSURANCE COMPANY OF CANADA | $84 | — | $84 | 0.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 400 N EXECUTIVE DRIVE STE 300 BROOKFIELD, WI 53005 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $7K | — | $7K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC. | 93033 131 S DEARBORN 6 FL CHICAGO, IL 60603 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $2K | — | $2K | 4.53% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 1300 SW 5TH AVENUE SUITE 500 PORTLAND, OR 97201 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $701 | — | $701 | 1.45% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | PO BOX 1650 MILWAUKEE, WI 53201 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $350 | — | $350 | 10.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 1166 AVENUE OF AMERICAS 22F NEW YORK, NY 10036 | FEDERAL INSURANCE COMPANY | $450 | — | $450 | 24.99% |
No Schedule C service providers reported on this filing.
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 | 648 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 262 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 916 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 2 | $73K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 2 | $69K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 950 | $48K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,028 | $375K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,028 | $375K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,028 | $375K |
| Other(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,028 | $446K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,028 | — |
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.