| 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 | $32K | $11K | $44K | 7.41% |
| WILLIS TOWERS WATSON US LLC7 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | $2K | $8K | 3.08% |
| WILLIS TOWERS WATSON US LLC7 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $892 | $1K | $2K | 2.11% |
| WILLIS TOWERS WATSON US LLC7 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $663 | $2K | 4.02% |
| WILLIS TOWERS WATSON US LLC7 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $247 | $2K | 6.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES, INC. EIN 22-0999690 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $733K |
| CVS PHARMACY, INC. EIN 05-0340626 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $188K |
| DELTA DENTAL EIN 11-1980218 NONE | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $80K |
| ACCLAIM, INC. EIN 72-1356116 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $51K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing; Direct payment from the plan; Participant communication Service code 12 | — | $26K |
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 | 2,034 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 75 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | GEISINGER HEALTH PLAN | 44 | $904K |
| Vision | VISION SERVICE PLAN | 1,577 | $281K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 3,736 | $588K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 330 | $98K |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,593 | $291K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 3,736 | $639K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,736 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.