| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE, INC. | PO BOX 28852 NEW YORK, NY 100878852 | METROPOLITAN LIFE INSURANCE COMPANY | $25K | $25K | $49K | 4.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE, INC. | PO BOX 741909 LOCKBOX #741909 ATLANTA, GA 303741909 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $33K | — | $33K | 9.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE, INC. | PO BOX 28852 COMMISSIONS LOCKBOX 28852 NEW YORK, NY 100878852 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 1.07% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWER WATSON DELAWARE,INC. | PO BOX 28852 NEW YORK, NY 100878852 | VISION SERVICE PLAN | $8K | — | $8K | 4.59% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON PENNSYLVANIA,INC. | PO BOX 8500 - STOP 9102 PHILADELPHIA, PA 191789102 | VISION SERVICE PLAN | $743 | — | $743 | 0.41% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 NONE | Claims processing; Other services Service code 12 | — | $837K |
| THE PRUDENTIAL INS.CO. OF AMERICA EIN 22-1211670 NONE | Plan Administrator; Other fees Service code 14 | — | $66K |
| TOWERS WATSON DELAWARE INC NONE | Other commissions Service code 55 | 1 STAMFORD PLZ 263 TRESSER BLVD STAMFORD, CT 069013271 | $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 | 1,694 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 287 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 9 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,990 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 3,011 | $1.2M |
| Vision | VISION SERVICE PLAN | 1,023 | $182K |
| Life insurance(2 contracts, 2 carriers) | GRANGE LIFE INSURANCE COMPANY | 1,924 | $2.1M |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,140 | $367K |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 3,440 | $533K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,440 | — |
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.