| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 | 335 MADISON AVE FL 20 NEW YORK, NY 10017 | RELIASTAR LIFE INSURANCE COMPANY OF NEW YORK | — | $223K | $223K | 6.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE, INC. | P.O. BOX 28852 NEW YORK, NY 10087 | THE HARTFORD | — | $15K | $15K | 1.22% |
| WILLIS TOWERS WATSON US LLC3 | P.O. BOX 28852 NEW YORK, NY 10087 | FIRST UNUM LIFE INSURANCE COMPANY | — | $12K | $12K | 1.34% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE, INC. | 1500 MARKET STREET CENTRE SQUARE EAST PHILADELPHIA, PA 19102 | THE GUARDIAN LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 NEW YORK, NY 10087 | FIRST UNUM LIFE INSURANCE COMPANY | — | $5K | $5K | 1.37% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE, INC. | 1500 MARKET STREET PHILADELPHIA, PA 19102 | EXCELLUS BLUE CROSS BLUE SHIELD | $964 | — | $964 | 4.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSUARCE CO EIN 59-1031071 CLAIM ADMINISTRATION | Contract Administrator; Direct payment from the plan; Claims processing; Other services; Participant communication; Named fiduciary; Non-monetary compensation; Float revenue Service code 12 | — | $153K |
| CIGNA | Contract Administrator; Claims processing; Non-monetary compensation; Participant communication; Other services; Named fiduciary; Direct payment from the plan; Float revenue 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 | 3,658 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 3,658 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 1 | $21K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY | 2,905 | $433K |
| Life insurance | THE HARTFORD | 3,658 | $1.2M |
| Long-term disability(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 2,503 | $1.3M |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 1 | $21K |
| Other(2 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY OF NEW YORK | 3,658 | $4.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,658 | — |
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.