| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AON CONSULTING INC3 Filed as: AON CONSULTING | PO BOX 905494 STE 400 CHARLOTTE, NC 28290 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $541 | — | $541 | 2.10% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | PO BOX 905494 STE 400 CHARLOTTE, NC 28290 | LIFE INSURANCE COMPANY OF NORTH AMERICA(CIGNA) | $708 | — | $708 | 3.96% |
| REUBEN WARNER ASSOCIATES, INC.4 | 1655 RICHMOND AVE. STATEN ISLAND, NY 10314 | ZURICH AMERICAN INSURANCE COMPANY | — | $321 | $321 | 14.99% |
| AON CONSULTING INC3 Filed as: AON RISK SOLUTIONS, INC. | 1120 20TH STREET, NW STE 600 WASHINGTON, DC 20036 | ZURICH AMERICAN INSURANCE COMPANY | $107 | — | $107 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA EIN 54-0357120 CLAIMS ADMINI STRATION | Other fees; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator; Claims processing Service code 12 | — | $150K |
| NETWORK ADMINISTRATORS DBA GSA EIN 11-3335620 ADMIN SUPPORT SERVICES | Direct payment from the plan Service code 50 | — | $86K |
| AON CONSUTLING, INC. | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $35K |
| DELTA DENTAL OF VIRGINIA EIN 54-0844477 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | — | $16K |
| VISION SERVICE PLAN EIN 23-7089668 CLAIMS ADMINI STRATIO | Contract Administrator Service code 13 | — | $10K |
| EXPRESS SCRIPTS, INC. 31-1714795 | Claims processing; Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $796 |
| FRYE & COMPANY, CPAS EIN 45-4199441 17600 | Accounting (including auditing) Service code 10 | — | $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 | 798 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 798 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 243 | $60K |
| Dental | DELTA DENTAL OF VIRGINIA | 308 | $127K |
| Vision | MID-ATLANTIC VISION SERVICES PLAN, INC. | 298 | $68K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA(CIGNA) | 56 | $18K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA(CIGNA) | 264 | $84K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA(CIGNA) | 137 | $52K |
| Prescription drug | EXPRESS SCRIPTS, INC. | 0 | $298K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA(CIGNA) | 264 | $84K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 308 | — |
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.