| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | PO BOX 905601 CHARLOTTE, NC 28290 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $15K | $15K | 1.22% |
| 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 | $70 | $1K | 0.09% |
| CORESOURCE, INC.3 | 18401 MAPLE CREEK DRIVE, SUITE 300 TINLEY PARK, IL 60477 | HCC LIFE INSURANCE COMPANY | — | $18K | $18K | 1.57% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE | 8285 TOURNAMENT DRIVE SUITE 130 MEMPHIS, TN 38125 | HIGHMARK CASUALTY INSURANCE COMPANY | $9K | — | $9K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE | 8285 TOURNAMENT DRIVE SUITE 130 MEMPHIS, TN 38125 | ONE AMERICA | $9K | — | $9K | 10.39% |
| CORPORATE BENEFITS CONSULTANTS INC3 Filed as: CORPORATE BENEFITS CONSULTANTS | 8500 BROOKTREE ROAD SUITE 305 WEXFORD, PA 15090 | ONE AMERICA | $21 | — | $21 | 0.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE, INC. | 26 CENTURY BLVD NASHVILLE, TN 37214 | UNITED CONCORDIA INSURANCE COMPANY | $2K | — | $2K | 4.48% |
| 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 | $2K | — | $2K | 3.49% |
| 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 | — | $858 | $858 | 2.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORESOURCE EIN 35-1846036 NONE | Direct payment from the plan; Other services; Plan Administrator; Claims processing Service code 12 | — | $727K |
| AETNA PPO EIN 06-6033492 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $265K |
| HIGHMARK, INC. EIN 23-1294723 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $103K |
| BENEFIT OUTSOURCING GROUP EIN 46-0503783 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $96K |
| MULTIPLAN EIN 43-6004435 NONE | Direct payment from the plan; Other services; Plan Administrator; Claims processing Service code 12 | — | $70K |
| HEALTH FITNESS EIN 41-1580506 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $17K |
| DENTEMAX EIN 38-2612296 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $12K |
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 | 2,057 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 478 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 102 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,637 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH ALLIANCE MEDICAL PLANS | 90 | $534K |
| Dental(3 contracts, 3 carriers) | DELTA DENTAL OF PENNSYLVANIA | 239 | $145K |
| Vision(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 92 | $62K |
| Life insurance(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,057 | $1.4M |
| Short-term disability | ONE AMERICA | 140 | $90K |
| Long-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,057 | $1.4M |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 5 | $53K |
| Stop-loss / reinsurancereinsurance(3 contracts, 3 carriers) | HCC LIFE INSURANCE COMPANY | 1,813 | $1.4M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,057 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,057 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.