| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND, INC | 12505 PARK POTOMAC AVE POTOMAC, MD 20854 | AETNA | $3K | — | $3K | 0.89% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS FINANCIAL SER | 12404 PARK CENTRAL DR DALLIS, TX 75251 | AETNA | $1K | — | $1K | 0.31% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND, INC. | 12505 PARK POTOMAC AVE POTOMAC, MD 20854 | DELTA DENTAL OF PENNSYLVANIA | $2K | — | $2K | 10.00% |
| MATHER & STROHL ADMIN SVCS INC3 | 12404 PARK CENTRAL SUITE 400S DALLAS, TX 75251 | HARTFORD LIFE AND ACCIDENT | $2K | $446 | $3K | 22.33% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND, INC. | PO BOX 13784 NEWARK, NJ 07188 | VISION SERVICE PLAN | $527 | — | $527 | 9.51% |
| CENTERSTONE INSURANCE AND FINANCIAL3 | SERVICES 12404 PARK CENTRAL DR STE 400 DALLAS, TX 75251 | VISION SERVICE PLAN | $276 | — | $276 | 4.98% |
No Schedule C service providers reported on this filing.
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 | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA | 0 | $329K |
| Dental | DELTA DENTAL OF PENNSYLVANIA | 0 | $17K |
| Vision | VISION SERVICE PLAN | 0 | $6K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 0 | $12K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 0 | $12K |
| Prescription drug | AETNA | 0 | $329K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.