| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEARY BENEFITS GROUP, INC.3 Filed as: CLEARY BENEFITS GROUP INC. | 83 WOOSTER HEIGHTS RD DANBURY, CT 06850 | SUN LIFE ASSURANCE COMPANY OF CANADA | $219K | — | $219K | 2.81% |
| CLEARY BENEFITS GROUP, INC.3 Filed as: CLEARY BENEFITS GROUP INC. | 83 WOOSTER HEIGHTS RD DANBURY, CT 06810 | UNITED HEALTHCARE INSURANCE COMPANY | $31K | — | $31K | 5.06% |
| MERCER HEALTH AND BENEFITS, LLC Filed as: MERCER | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | ZURICH AMERICAN INSURANCE COMPANY | $5K | — | $5K | 20.00% |
| CLEARY BENEFITS GROUP, INC.3 Filed as: CLEARY BENEFITS GROUP INC | 83 WOOSTER HEIGHTS RD DANBURY, CT 06810 | SUN LIFE AND HEALTH INSURANCE COMPANY (U.S.) | $906 | — | $906 | 9.83% |
| CLEARY BENEFITS GROUP, INC. Filed as: CLEARY BENEFITS GROUP INC. | 83 WOOSTER HEIGHTS RD DANBURY, CT 06810 | SUN LIFE INSURANCE COMPANY OF CANADA | $27 | $0 | $27 | 2.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing; Other commissions Service code 12 | — | $2.6M |
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CLAIM ADMINISTRATION | Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Named fiduciary; Contract Administrator; Float revenue; Participant communication Service code 12 | 1601 CHESTNUT ST PHILADELPHIA, PA 19192 | $2.2M |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $266K |
| CIGNA BEHAVIORAL HEALTH INC. EIN 41-1648670 PLAN ADMINISTRATOTR | Contract Administrator; Direct payment from the plan; Claims processing; Participant communication Service code 12 | 11095 VIKING DRIVE EDEN PRAIRIE, MN 55344 | $202K |
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 | 11,291 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 11,291 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 2,775 | $589K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 14,640 | $615K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 22,030 | $7.8M |
| Short-term disability(3 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 22,030 | $7.8M |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 22,030 | $7.8M |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 9,381 | $2.1M |
| Other | ZURICH AMERICAN INSURANCE COMPANY | 11,978 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 22,030 | — |
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.