| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $36K | — | $36K | 5.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $21K | — | $21K | 6.89% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | — | $9K | 5.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO EIN 53-1091071 CLAIMS ADMINISTRATOR | Named fiduciary; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Participant communication; Other services; Float revenue; Claims processing Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $1.6M |
| LIFE INSURANCE COMPANY OF N. A. EIN 23-1503749 CLAIMS/CONTRACT ADMIN | Claims processing; Contract Administrator Service code 12 | PO BOX 20643 LEHIGH VALLEY, PA 18002 | $143K |
| TOWERS WATSON DELAWARE EIN 53-0181291 CONSULTANT | Insurance agents and brokers Service code 22 | LOCKBOX 741909 PO BOX 741909 ATLANTA, GA 30374 | $130K |
| DELTA DENTAL MINNESOTA EIN 41-1905554 CLAIMS ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | PO BOX 9304 MINNEAPOLIS, MN 55440 | $96K |
| UNITED BEHAVIORAL HEALTH DBA OPTUM EIN 94-2649097 CONTRACT ADMINISTRATION | Contract Administrator Service code 13 | P OBOX 39000 SAN FRANCISCO, CA 94139 | $87K |
| DISCOVERY BENEFITS EIN 90-0058554 CLAIMS/CONTRACT ADMIN | Contract Administrator; Claims processing Service code 12 | 4321 20TH AVENUE FARGO, ND 58103 | $49K |
| CIGNA LIFE INSURANCE CO OF NY EIN 13-2556568 CLAIMS/CONTRACT ADMIN | Claims processing; Contract Administrator Service code 12 | PO BOX 20643 LEHIGH VALLEY, PA 18002 | $1K |
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 | 3,033 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 27 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,060 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,881 | $712K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,811 | $306K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,811 | $192K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,881 | — |
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.