| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC. | PO BOX 13784 NEWARK, NJ 07188 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES | $15K | $444 | $15K | 3.79% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | PO BOX 905494, STE 400 CHARLOTTE, NC 28290 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $10K | — | $10K | 4.50% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | PO BOX 905494, STE 400 CHARLOTTE, NC 28290 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 4.50% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | PO BOX 905494, STE 400 CHARLOTTE, NC 28290 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 4.50% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC. | 12505 PARK POTOMAC AVE POTOMAC, MD 20874 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 3.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND, INC. | PO BOX 13784 NEWARK, NJ 071880001 | VISION SERVICE PLAN | $3K | — | $3K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC. | PO BOX 13784 NEWARK, NJ 07188 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $3K | — | $3K | 8.24% |
| MCCULLUGH, CHRISTINE M3 Filed as: MCCULLUGH, CHRISTINE M. | 14715 NE 95TH ST, STE 200 REDMOND, WA 98052 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 15.57% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC. | PO BOX 13784 NEWARK, NJ 071880784 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $68 | $1K | 5.52% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC. | 12505 PARK POTOMAC AVE POTOMAC, MD 20874 | MONUMENTAL LIFE INSURANCE COMPANY | $549 | — | $549 | 4.51% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | PO BOX 905494, STE 400 CHARLOTTE, NC 28290 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $515 | — | $515 | 4.50% |
| THOMAS C SMITH3 Filed as: THOMAS C. SMITH | 2928 FOSTER CREIGHTON DR. NASHVILLE, TN 37204 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $631 | — | $631 | 8.54% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND, INC. | 12505 POTOMAC AVE POTOMAC, MD 20874 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $67 | — | $67 | 0.91% |
| ASHLEY L. DEMATTEO3 Filed as: ASHLEY DEMATTEO | 2928 FOSTER CREIGHTON DR. NASHVILLE, TN 37204 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $33 | — | $33 | 0.45% |
No Schedule C service providers reported on this filing.
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 | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES | 0 | $486K |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 0 | $107K |
| Vision | VISION SERVICE PLAN | 0 | $51K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $223K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $121K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $122K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES | 0 | $408K |
| Other(4 contracts, 4 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 0 | $111K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.