| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $50K | — | $50K | 1.59% |
| IMG5 | 2960 NORTH MERIDIAN ST INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $1K | $1K | 0.03% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX101162 PASADENA, CA 91189 | CIGNA LIFE AND HEALTH INSURANCE COMPANY | $122K | — | $122K | 10.45% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC. | PO BOX 4557 NEW YORK, NY 10249 | HIGHMARK WESTERN AND NORTHEASTERN NEW YORK INC. | $28K | — | $28K | 2.43% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SERV | 13065 COLLECTIONS CENTRE DR. CHICAGO, IL 60693 | BLUECROSS BLUESHIELD OF NEW MEXICO | $25K | — | $25K | 3.87% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 13784 NEWARK, NJ 07188 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE CO. | $12K | $126 | $12K | 10.17% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE CO. | — | $4K | $4K | 3.24% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE, INC. | 29982 NETWORK PLACE CHICAGO, IL 60673 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE CO. | — | $2K | $2K | 1.99% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 12505 PARK POTOMAC AVE SUITE 300 POTOMAC, MD 20854 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA, IN EIN 54-0357120 TPA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Float revenue; Contract Administrator Service code 12 | — | $2.1M |
| TELUS HEALTH LTD EIN 52-1883918 EAP PROVIDER | Other services Service code 49 | — | $260K |
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 | 3,376 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 3,376 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(7 contracts, 6 carriers) | CIGNA LIFE AND HEALTH INSURANCE COMPANY | 191 | $3.1M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF NORTH CAROLINA | 8,974 | $10.8M |
| Vision | VSP | 3,020 | $374K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 5,457 | $3.2M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 5,457 | $3.2M |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 5,457 | $3.2M |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 2,590 | $2.5M |
| Other(2 contracts, 2 carriers) | CIGNA LIFE AND HEALTH INSURANCE COMPANY | 618 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,974 | — |
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.