| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC | 12505 PARK POTOMAC AVE STE 300 POTOMAC, MD 20854 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $40K | $9K | $48K | 18.28% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | PO BOX 13784 NEWARK, NJ 07188 | VISION SERVICE PLAN | $2K | — | $2K | 5.67% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND, INC. | PO BOX 13784 NEWARK, NJ 07188 | VISION SERVICE PLAN | $2K | — | $2K | 4.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE LOOMIS COMPANY EIN 23-2238132 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $190K |
| WILLIS OF MARYLAND, INC EIN 52-0559369 NONE | Contract Administrator; Direct payment from the plan; Insurance brokerage commissions and fees Service code 13 | — | $120K |
| CIGNA EIN 35-2029627 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $61K |
| ZELIS CLAIMS INTEGRITY INC. EIN 86-1040704 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $25K |
| HINES & ASSOCIATES EIN 36-3545085 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $21K |
| TELADOC INC. EIN 04-3705970 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $7K |
| CIGNA DENTAL EIN 35-2029627 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $6K |
| EVOLUTIONS HEALTHCARE SYSTEMS EIN 59-3139483 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $1K |
| OPTUM EIN 41-1858498 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $337 |
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 | 379 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 25 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 404 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 249 | $40K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 412 | $265K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 412 | $265K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 412 | $265K |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 306 | $847K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 412 | $265K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 412 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.