| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 | PO BOX 288852 COMMISSION LOCKBOX 28852 NEW YORK, NY 10087 | SUN LIFE ASSURANCE COMPANY OF CANADA | $50K | $18K | $68K | 8.42% |
| WILLIS TOWERS WATSON US LLC7 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $3K | $12K | 3.63% |
| WILLIS TOWERS WATSON US LLC7 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $2K | $5K | 2.14% |
| WILLIS TOWERS WATSON US LLC7 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $525 | $4K | 2.81% |
| WILLIS TOWERS WATSON US LLC7 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $849 | $334 | $1K | 2.09% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MASS. EIN 04-1045815 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $916K |
| CVS PHARMACY, INC. EIN 05-0340626 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $133K |
| ACCLAIM, INC. EIN 72-1356116 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $71K |
| DELTA DENTAL EIN 11-1980218 NONE | Contract Administrator; Claims processing; Direct payment from the plan Service code 12 | — | $60K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 NONE | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $49K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 NONE | Direct payment from the plan; Contract Administrator; Participant communication; Claims processing Service code 12 | — | $31K |
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 | 2,439 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 100 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,539 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | GEISINGER QUALITY OPTIONS, INC. | 85 | $983K |
| Vision | VISION SERVICE PLAN | 1,866 | $287K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 4,435 | $808K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 576 | $243K |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,206 | $397K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 4,435 | $940K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,435 | — |
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."
No prospect flags tripped on this filing.