| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | P.O. BOX 741909 LOCKBOX 741909 ATLANTA, GA 303741909 | RELISTAR LIFE INSURANCE COMPANY | — | $119K | $119K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | COM LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | MINNESOTA LIFE INSURANCE COMPANY | — | $42K | $42K | 2.30% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | 199 WATERS STREET NEW YORK, NY 10038 | NATIONAL UNION INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 41-0984460 NONE | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $2.8M |
| DELTA DENTAL EIN 41-1905554 NONE | Claims processing Service code 12 | — | $248K |
| EXPRESS SCRIPTS EIN 43-1420563 NONE | Claims processing Service code 12 | — | $129K |
| UNITED HEALTHCARE SERVICES INC EIN 41-1289245 NONE | Other services; Claims processing 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 | 9,385 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 125 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 9,510 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 232 | $1.9M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 45 | $543K |
| Life insurance(2 contracts, 2 carriers) | MINNESOTA LIFE INSURANCE COMPANY | 9,552 | $1.8M |
| Short-term disability | STANDARD INSURANCE COMPANY | 8,488 | $1.8M |
| Long-term disability | STANDARD INSURANCE COMPANY | 8,488 | $1.8M |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 232 | $1.9M |
| Stop-loss / reinsurancereinsurance | RELISTAR LIFE INSURANCE COMPANY | 7,385 | $2.4M |
| Other | MINNESOTA LIFE INSURANCE COMPANY | 9,552 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,552 | — |
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.