| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELEWARE INC. | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | BERKLEY LIFE AND HEALTH INSURANCE COMPANY | — | $71K | $71K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CONTRACT ADMINISTRATOR | Other services; Float revenue; Contract Administrator; Named fiduciary; Non-monetary compensation; Claims processing; Participant communication; Direct payment from the plan Service code 12 | — | $1.2M |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 THIRD PARTY ADMINISTRATO | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 100 PARSONS POND DRIVE FRANKLIN LAKES, NJ 07417 | $132K |
| DELTA DENTAL OF MISSOURI EIN 43-0908349 THIRD PARTY ADMINISTRATO | Claims processing; Contract Administrator Service code 12 | 12399 GRAVOIS ROAD ST LOUIS, MO 63127 | $112K |
| CAREOPERATIVE, LLC EIN 46-4399706 NONE | Other services Service code 49 | 330 FRANKLIN ROAD, SUITE 135A-428 BRENTWOOD, TN 37027 | $37K |
| WILLIS TOWERS WATSON EIN 26-0775680 NONE | Contract Administrator Service code 13 | 2929 CAMPUS DRIVE, SUITE 400 SAN MATEO, CA 94403 | $22K |
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 | 2,459 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 83 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,542 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN INSURANCE COMPANY | 1,945 | $239K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | BERKLEY LIFE AND HEALTH INSURANCE COMPANY | 2,003 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,003 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.