| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FREDERICK W. HOWARTH III3 Filed as: FREDERICK HOWARTH III | 6077 BRISTOL PARKWAY CULVER CITY, CA 90230 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $92K | $92K | 11.40% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | PO BOX 28852 NEW YORK, NY 100878852 | METROPOLITAN LIFE INSURANCE COMPANY | — | $9K | $9K | 1.68% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON PENNSYLVANIA INC. | PO BOX 9102 PO BOX 8500 PHILADELPHIA, PA 191788500 | METROPOLITAN LIFE INSURANCE COMPANY | — | $445 | $445 | 0.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITEDHEALTHCARE INSURANCE COMPANY EIN 36-2739571 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $616K |
| EXPRESS SCRIPTS EIN 43-1420563 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $100K |
| MEDICAL MUTUAL OF OHIO EIN 34-0648820 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $89K |
| INFINISOURCE EIN 38-2976613 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $10K |
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 | 1,296 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 19 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,315 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | DELAWARE AMERICAN LIFE INSURANCE COMPANY | 44 | $444K |
| Dental | AETNA LIFE INSURANCE COMPANY | 2,379 | $1.1M |
| Vision | VISION SERVICE PLAN | 687 | $147K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,850 | $985K |
| Long-term disability(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,296 | $1.2M |
| Other(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,850 | $994K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,379 | — |
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.