| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | HARTFORD LIFE AND ACCIDENT | — | $120K | $120K | 1.66% |
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 NEW YORK, NY 100878852 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $3K | $3K | 1.44% |
| REUBEN WARNER ASSOCIATES, INC.3 | 1655 RICHMOND AVENUE STATEN ISLAND, NY 10314 | ACE AMERICAN INSURANCE COMPANY | — | $10K | $10K | 20.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 NONE | Other services; Claims processing; Direct payment from the plan Service code 12 | — | $2.5M |
| OPTUM HSA NONE | Contract Administrator; Direct payment from the plan Service code 13 | 11000 OPTUM CIRCLE EDEN PRAIRIE, MN 55344 | $2.0M |
| LIVONGO NONE | Direct payment from the plan; Contract Administrator Service code 13 | 150 W. EVELYN AVENUE SUITE 150 MOUNTAIN VIEW, CA 94041 | $905K |
| CVS CAREMARK EIN 05-0340626 NONE | Direct payment from the plan; Claims processing; Contract Administrator Service code 12 | — | $251K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $204K |
| MDLIVE NONE | Contract Administrator; Direct payment from the plan Service code 13 | 3350 SW 148TH AVENUE SUITE 300 MIRAMAR, FL 33027 | $79K |
| UNITED BEHAVIORAL HEALTH DBA OPTUM EIN 94-2649097 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $35K |
| RUBIN BROWN LLP EIN 43-0765316 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $23K |
| BANK OF AMERICA EIN 94-1687665 NONE | Float revenue; Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $8K |
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 | 5,357 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 829 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 6,186 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 24 | $206K |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 24 | $203K |
| Vision(2 contracts) | EYEMED VISION CARE C/O COMBINED INSURANCE CO. OF AMERICA | 10,398 | $594K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 6,063 | $7.2M |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 6,063 | $7.2M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 6,063 | $7.2M |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 6,063 | $7.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,398 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.