| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | PO BOX 8500 S-6110 PHILADELPHIA, PA 19178 | SYMETRA LIFE INSURANCE COMPANY | — | $16K | $16K | 3.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 CONTRACT ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Other services; Claims processing Service code 12 | — | $645K |
| WELLS FARGO BANK N.A. EIN 94-1347393 TRUSTEE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $68K |
| EXPRESS SCRIPTS EIN 43-1420563 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $65K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $48K |
| VISION SERVICE PLAN EIN 23-7089668 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $22K |
| AON HEWITT EIN 36-2235791 RECORDKEEPER | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees Service code 15 | — | $18K |
| CLARK SCHAEFER HACKETT EIN 31-0800053 AUDITOR | Accounting (including auditing) Service code 10 | — | $16K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2,509 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,509 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 2,509 | $570K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 1,888 | $397K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,509 | — |
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.