| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | EMBLEM HEALTH | $10K | — | $10K | 2.62% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON PENNSYLVANIA | LOCKBOX #9102, PO BOX 8500 PHILADELPHIA, PA 19178 | AETNA HEALTH INC. (A NEW YORK CORPORATION) | $427 | — | $427 | 0.84% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | AETNA HEALTH INC. (A NEW YORK CORPORATION) | $390 | — | $390 | 0.76% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE (RHC) | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | UNITED HEALTHCARE INSURANCE COMPANY | $4K | — | $4K | 14.56% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Float revenue; Participant communication; Direct payment from the plan; Other services; Named fiduciary; Contract Administrator; Claims processing; Non-monetary compensation Service code 12 | — | $1.8M |
| COHNREZNICK LLP EIN 22-1478099 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $66K |
| BUCK CONSULTANTS LLC EIN 13-3954297 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $21K |
| ERNST AND YOUNG EIN 34-6565596 NONE | Direct payment from the plan; Other services; Other fees Service code 49 | — | $6K |
| STATE STREET BANK AND TRUST COMPANY EIN 04-1867445 NONE | Trustee (directed); Float revenue; Direct payment from the plan; Other fees; Investment management Service code 25 | — | $2K |
| CIGNA | Other services; Non-monetary compensation; Claims processing; Direct payment from the plan; Float revenue; Named fiduciary; Participant communication; Contract Administrator 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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4,534 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,534 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | EMBLEM HEALTH | 54 | $394K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 56 | — |
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.