| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC0 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | FOUR EVER LIFE INS. CO. | $473 | $59 | $532 | 4.50% |
| ANTHEM INSURANCE COMPANIES, INC.0 | 120 MONUMENT CIRCLE INDIANAPOLIS, IN 462044903 | FOUR EVER LIFE INS. CO. | $473 | $59 | $532 | 4.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 CLAIMS PROCESSOR | Claims processing; Contract Administrator; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other services; Other fees Service code 12 | — | $186K |
| ALIGHT BENEFITS ADMINISTRATOR | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | 100 HALF DAY ROAD LINCOLNSHIRE, IL 60069 | $38K |
| CROSSOVER HEALTH EIN 27-2210284 CONTRACTOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $31K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 CONTRACTOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $9K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 CONTRACTOR | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $9K |
| VISION SERVICE PLAN EIN 94-1632821 CONTRACTOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $5K |
| WAGEWORKS EIN 20-0198855 CONTRACTOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $5K |
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 | 4,972 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 923 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 4 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 5,895 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | FOUR EVER LIFE INS. CO. | 7 | $12K |
| Dental(2 contracts) | DELTA DENTAL OF NEW YORK | 4,451 | $29K |
| Vision | VISION SERVICE PLAN | 4,821 | $46K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,821 | — |
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.