| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTEGRO INSURANCE BROKERS3 Filed as: INTEGRO USA INC. | PO BOX 5682 CAROL STREAM, IL 60197 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $112K | — | $112K | 3.74% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE IN | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $16K | $19K | $34K | 1.15% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | 210 EAST 5TH STREET, STE 1250 CINCINNATI, OH 45202 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $234 | $234 | 0.02% |
| INTEGRO INSURANCE BROKERS3 Filed as: INTEGRO USA INC. | PO BOX 5682 CAROL STREAM, IL 60197 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $67K | — | $67K | 12.50% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE IN | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $20K | $3K | $22K | 4.17% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE IN | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $1K | $5K | 2.13% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE IN | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $312 | $2K | 5.15% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MASS. EIN 04-1045815 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $1.1M |
| CVS PHARMACY, INC. EIN 05-0340626 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $370K |
| ACCLAIM, INC. EIN 72-1356116 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $73K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 NONE | Direct payment from the plan; Contract Administrator; Claims processing; Participant communication Service code 12 | — | $44K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 NONE | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $43K |
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 | 3,162 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 35 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 286 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,483 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 75 | $1.7M |
| Vision | VISION SERVICE PLAN | 2,304 | $349K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 5,382 | $1.2M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,054 | $217K |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,267 | $3.0M |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 5,382 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,382 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.