| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VERASOURCE3 | 8525 EDINBROOK CROSSING BROOKLYN PARK, MN 55443 | ZURICH AMERICAN INSURANCE COMPANY | — | $56K | $56K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC | 200 LIBERTY STREET NEW YORK, NY 10281 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | $24K | — | $24K | 2.93% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC | 200 LIBERTY ST NEW YORK, NY 102811003 | UNITED HEALTHCARE INSURANCE COMPANY | — | — | $0 | 0.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC | ONE WORLD FINANCIAL NEW YORK, NY 10281 | UNITED HEALTHCARE INSURANCE COMPANY | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES INC EIN 22-0999690 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 3 PENN PLAZA EAST NEWARK, NJ 07105 | $808K |
| WILLIS OF MASSACHUSETTS INC | Insurance agents and brokers Service code 22 | ONE WORLD FINANCIAL NEW YORK, NY 10004 | $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 | 3,317 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 72 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,389 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AETNA LIFE INSURANCE CO | 810 | $200K |
| Vision(2 contracts) | UNITED HEALTHCARE INSURANCE COMPANY | 903 | $196K |
| Life insurance | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 3,135 | $828K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 3,135 | $828K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 3,135 | $828K |
| Stop-loss / reinsurancereinsurance | ZURICH AMERICAN INSURANCE COMPANY | 2,302 | $1.1M |
| Other | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 3,135 | $828K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,135 | — |
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.