| 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 | — | $25K | $25K | 2.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC | ONE WORLD FINANCIAL CENTER 200 LIBERTY ST. NEW YORK, NY 10281 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $40 | $1K | 0.09% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE | 8285 TOURNAMENT DRIVE SUITE 130 MEMPHIS, TN 38125 | HIGHMARK CASUALTY INSURANCE COMPANY | $8K | — | $8K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE | 8285 TOURNAMENT DRIVE SUITE 130 MEMPHIS, TN 38125 | ONE AMERICA | $11K | — | $11K | 10.08% |
| CORPORATE BENEFITS CONSULTANTS INC3 Filed as: CORPORATE BENEFITS CONSULTANTS | 8500 BROOKTREE ROAD SUITE 305 WEXFORD, PA 15090 | ONE AMERICA | $2 | — | $2 | 0.00% |
| 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 | $3K | — | $3K | 4.72% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE | 26 CENTURY BLVD NASHVILLE, TN 37214 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $4K | — | $4K | 5.77% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA | 801 SOUTH FIGUEROA STREET FLOOR 7 LOS ANGELES, CA 90017 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | — | $1K | $1K | 3.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORESOURCE EIN 35-1846036 NONE | Claims processing; Other services; Plan Administrator Service code 12 | — | $1.0M |
| BENEFIT OUTSOURCING GROUP EIN 46-0503783 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $98K |
| HIGHMARK, INC. EIN 23-1294723 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $91K |
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 | 2,075 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 540 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 142 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,757 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH ALLIANCE MEDICAL PLANS | 92 | $486K |
| Dental(3 contracts, 3 carriers) | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 269 | $157K |
| Vision(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 120 | $83K |
| Life insurance(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,075 | $1.3M |
| Short-term disability | ONE AMERICA | 153 | $104K |
| Long-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,075 | $1.3M |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 10 | $73K |
| Stop-loss / reinsurancereinsurance(3 contracts, 3 carriers) | HCC LIFE INSURANCE COMPANY | 1,828 | $1.4M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,075 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,075 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.