| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOIS INC. | 10 SOUTH LASALLE STREET, SUITE 3000 CHICAGO, IL 60603 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $43K | — | $43K | 9.26% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOIS INC. | 233 S. WACKER DRIVE SUITE 2000 CHICAGO, IL 60606 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $47K | $5K | $51K | 17.88% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOIS INC | 233 SOUTH WACKER DRIVE, SUITE 2000 CHICAGO, IL 60606 | SUN LIFE ASSURANCE COMPANY OF CANADA | $28K | — | $28K | 12.57% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS HRH | 425 N MARTINGALE ROAD SUITE 1100 SCHAUMBURG, IL 60173 | EYEMED VISION CARE | $19K | — | $19K | 8.71% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOIS INC | 233 S WACKER DR SUITE 2000 CHICAGO, IL 60606 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | $3K | $14K | 13.37% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOIS INC | 233 S WACKER DR SUITE 2000 CHICAGO, IL 60606 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $850 | $4K | 6.57% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC. | ONE WFC - 200 LIBERTY STREET NEW YORK, NY 10281 | HARTFORD LIFE AND ACCIDENT | $0 | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CONTRACT ADMINISTRATOR | Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Named fiduciary Service code 12 | — | $1.1M |
| BLUE CROSS BLUE SHIELD OF MI EIN 38-2069753 TPA | Claims processing; Other fees; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Direct payment from the plan; Contract Administrator; Insurance services Service code 12 | — | $107K |
| DELTA DENTAL EIN 36-2612058 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $71K |
| CIGNA HEALTH AND LIFE INS. COMPANY | Other services; Direct payment from the plan; Contract Administrator; Participant communication; Float revenue; Named fiduciary; Non-monetary compensation; Claims processing Service code 12 | — | $0 |
| CIGNA HEALTH AND LIFE INSURANCE | Named fiduciary; Other services; Contract Administrator; Participant communication; Float revenue; Non-monetary compensation; Direct payment from the plan; Claims processing Service code 12 | — | $0 |
| CIGNA HEALTH AND LIFE INSURANCE CO | Float revenue; Claims processing; Participant communication; Other services; Named fiduciary; Non-monetary compensation; Direct payment from the plan; Contract Administrator Service code 12 | — | $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 | 1,828 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 31 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,859 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE | 3,177 | $217K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,852 | $223K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,196 | $288K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 3,417 | $464K |
| Other(4 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,887 | $385K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,417 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.