| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 NEW YORK, NY 100878852 | METROPOLITAN LIFE INSURANCE COMPANY | — | $63K | $63K | 1.69% |
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 NEW YORK, NY 100878852 | METROPOLITAN LIFE INSURANCE COMPANY | — | $34 | $34 | 0.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON | 200 LIBERTY ST FLOOR 6 NEW YORK, NY 10281 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $30K | $30K | 1.50% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON | 200 LIBERTY ST FLOOR 6 NEW YORK, NY 10281 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $10K | $10K | 1.50% |
| LUIS LOPEZ LUNA3 | CALLE J #21 URB. VILLA CAPARRA GUAYNABO, PR 00966 | MCS LIFE INSURANCE COMPANY | $24K | — | $24K | 4.95% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 THIRD PARTY ADMIN. | Float revenue; Contract Administrator; Named fiduciary; Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Participant communication Service code 12 | — | $5.1M |
| EXPRESS SCRIPTS CONTRACT ADMIN. | Other services; Direct payment from the plan; Contract Administrator; Participant communication; Named fiduciary; Claims processing Service code 12 | ONE EXPRESS WAY ST LOUIS, MO 63121 | $504K |
| CONSUMER MEDICAL CONTRACT ADMIN. | Named fiduciary; Participant communication; Claims processing; Contract Administrator Service code 12 | 141 LONGWATER DRIVE SUITE 113-A NORWELL, MA 02061 | $213K |
| EVERNORTH BEHAVIORAL HEALTH INC EIN 41-1648670 PLAN ADMINISTRATOR | Contract Administrator; Direct payment from the plan; Claims processing; Participant communication Service code 12 | — | $84K |
| WAGEWORKS, INC. CONTRACT ADMIN | Claims processing; Contract Administrator; Participant communication Service code 12 | P.O. BOX 224547 DALLAS, TX 752224547 | $31K |
| CIGNA | Contract Administrator; Participant communication; Named fiduciary; Claims processing; Non-monetary compensation; Direct payment from the plan; Float revenue; 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 | 5,885 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 5,885 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MCS LIFE INSURANCE COMPANY | 34 | $489K |
| Dental | MCS LIFE INSURANCE COMPANY | 34 | $489K |
| Vision | EYEMED VISION CARE | 8,125 | $500K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 8,967 | $4.2M |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 5,696 | $647K |
| Long-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 5,070 | $2.0M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 8,967 | $3.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,967 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.