| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WASTON NORTHEAST INC | BANK OF AMERICA PO BOX 414965 BOSTON, MA 022414965 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $5K | $38K | $43K | 3.16% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST | PO BOX 414965 BOSTON, MA 02241 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 6.56% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST | PO BOX 414965 BOSTON, MA 02241 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 12.43% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST | PO BOX 414965 BOSTON, MA 02241 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 11.06% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC | PO BOX 414965 BOSTON, MA 022410001 | VISION SERVICE PLAN | $787 | — | $787 | 7.85% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST | PO BOX 414965 BOSTON, MA 02241 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $158 | — | $158 | 11.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIM & CONTRACT ADMIN | Participant communication; Other services; Contract Administrator; Non-monetary compensation; Named fiduciary; Float revenue; Direct payment from the plan; Claims processing Service code 12 | — | $6K |
| CIGNA | Named fiduciary; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Participant communication; Other services; Float revenue; Claims processing Service code 12 | — | $0 |
| CIGNA HEALTHY REWARDS VENDORS | Named fiduciary; Contract Administrator; Direct payment from the plan; Float revenue; Non-monetary compensation; Claims processing; Participant communication; Other services Service code 12 | — | $0 |
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 | 115 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 104 | $1.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 104 | $1.3M |
| Vision(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 104 | $1.4M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 129 | $10K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 129 | $45K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 129 | $23K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 129 | $1K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 129 | — |
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.