| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC. | 93245 NETWORK PLACE CHICAGO, IL 60673 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $38K | — | $38K | 6.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA INC | PO BOX 100003 PASADENA, CA 91189 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $7K | $7K | 1.04% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SERVICES OF GA INC | 1 GLENLAKE PKWY 11TH FLOOR ATLANTA, GA 30328 | HUMANA HEALTH PLAN OF OHIO, INC. | $2K | — | $2K | 0.40% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC. | 200 PUBLIC SQUARE SUITE 3760 BP TOWER CLEVELAND, OH 44114 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 2.34% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO, INC. | 93245 NETWORK PLACE CHICAGO, IL 60673 | PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA INC | $3K | — | $3K | 2.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $876K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 SERVICE PROVIDER | Other services; Insurance services; Direct payment from the plan; Claims processing Service code 12 | — | $50K |
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 | 2,397 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 38 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 57 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,492 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | HEALTHSPAN INTEGRATED CARE | 74 | $1.3M |
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 2,397 | $759K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 7 | $263 |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 2,397 | $759K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,397 | — |
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.