| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON PENNSYLVANIA INC | 335 MADISON AVE NEW YORK, NY 100174611 | SYMETRA LIFE INSURANCE COMPANY | — | $38K | $38K | 5.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 INSURANCE PROVIDER | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue; Other fees; Claims processing; Other services Service code 12 | — | $1.4M |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 INSURANCE PROVIDER | Contract Administrator; Claims processing Service code 12 | — | $77K |
| CAREMARK PHARMACEUTICAL SVCS GROUP | Float revenue; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $23K |
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 | 2,588 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 897 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,485 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 2,428 | $1.2M |
| Dental(3 contracts) | DELTA DENTAL OF INDIANA | 5,987 | $1.9M |
| Vision | VISION SERVICE PLAN | 1,611 | $437K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 5,225 | $3.0M |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 5,225 | $3.0M |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 2,431 | $657K |
| Other(4 contracts, 4 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 5,821 | $3.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,987 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.