| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CORESOURCE, INC.3 | 18401 MAPLE CREEK DRIVE, SUITE 300 TINLEY PARK, IL 60477 | HCC LIFE INSURANCE COMPANY | — | $26K | $26K | 2.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | PO BOX 905601 CHARLOTTE, NC 28290 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $7K | $8K | 0.74% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE | 8285 TOURNAMENT DRIVE SUITE 130 MEMPHIS, TN 38125 | HEALTH ALLIANCE MEDICAL PLANS | $3K | — | $3K | 0.83% |
| INSURANCE PROGRAMMERS, INC.3 | 10 TECHNOLOGY DRIVE WALLINGFORD, CT 06492 | STANDARD LIFE & ACCIDENT INSURANCE COMPANY | $31K | — | $31K | 12.47% |
| CORPORATE BENEFIT CONSULTANTS3 | 8500 BROOKTREE ROAD SUITE 305 WEXFORD, PA 15090 | HIGHMARK CASUALTY INSURANCE COMPANY | $6K | — | $6K | 3.44% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE | 8285 TOURNAMENT DRIVE SUITE 130 MEMPHIS, TN 38125 | HIGHMARK CASUALTY INSURANCE COMPANY | $3K | — | $3K | 1.56% |
| CORPORATE BENEFITS CONSULTANTS INC3 Filed as: CORPORATE BENEFITS CONSULTANTS | 8500 BROOKTREE ROAD SUITE 305 WEXFORD, PA 15090 | ONE AMERICA | $8K | — | $8K | 7.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE | 8285 TOURNAMENT DRIVE SUITE 130 MEMPHIS, TN 38125 | ONE AMERICA | $5K | — | $5K | 4.18% |
| PEOPLES UNITED INSURANCE AGENCY INC3 | 1 GOODWIN SQ HARTFORD, CT 06103 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | — | $4K | 4.40% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | 8285 TOURNAMENT DRIVE SUITE 130 MEMPHIS, TN 38125 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $31 | $3K | 3.61% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | 806 TYVOLA ROAD SUITE 108 CHARLOTTE, NC 28217 | METROPOLITAN LIFE INSURANCE COMPANY | — | $650 | $650 | 0.70% |
| CORPORATE BENEFITS CONSULTANTS INC3 Filed as: CORPORATE BENEFITS CONSULTANTS | 8500 BROOKTREE ROAD SUITE 305 WEXFORD, PA 15090 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $2K | — | $2K | 2.69% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE | 26 CENTURY BLVD NASHVILLE, TN 37214 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $2K | — | $2K | 2.64% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | 8285 TOURNAMENT DRIVE SUITE 130 MEMPHIS, TN 38125 | BLUE CROSS BLUE SHIELD OF ARIZONA | $4K | — | $4K | 5.30% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF GA | 801 SOUTH FIGUEROA STREET FLOOR 7 LOS ANGELES, CA 90017 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | — | $1K | $1K | 3.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORESOURCE EIN 35-1846036 NONE | Claims processing; Plan Administrator; Other services Service code 12 | — | $1.0M |
| BENEFIT OUTSOURCING GROUP EIN 46-0503783 NONE | Contract Administrator Service code 13 | — | $99K |
| BASIC EIN 38-2883561 NONE | Contract Administrator Service code 13 | — | $58K |
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 | 2,006 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 570 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 157 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,733 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HEALTH ALLIANCE MEDICAL PLANS | 79 | $724K |
| Dental(4 contracts, 4 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 227 | $259K |
| Vision(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 135 | $80K |
| Life insurance(4 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,006 | $1.3M |
| Short-term disability(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,006 | $1.3M |
| Long-term disability(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,006 | $1.3M |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 9 | $69K |
| Stop-loss / reinsurancereinsurance(3 contracts, 3 carriers) | HCC LIFE INSURANCE COMPANY | 1,881 | $1.5M |
| Other(4 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,006 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,006 | — |
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.