| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND, INC | 600 GRANT ST PITTSBURGH, PA 15219 | UPMC HEALTH PLAN | $42K | — | $42K | 13.38% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 13784 NEWARK, NJ 07188 | CIGNA HEALTH & LIFE INSURANCE COMPANY | $19K | — | $19K | 17.16% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | P O BOX 13784 NEWARK, NJ 071880001 | VISION SERVICE PLAN | $8K | — | $8K | 7.95% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHWEST, INC | PO BOX 13784 NEWARK, NJ 071880001 | VISION SERVICE PLAN | — | — | $0 | 0.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | P O BOX 13784 NEWARK, NJ 07188 | CIGNA HEALTH & LIFE INSURANCE COMPANY | $4K | — | $4K | 8.49% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC | P O BOX 13784 NEWARK, NJ 07188 | CIGNA HEALTH & LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 12505 PARK POTOMAC AVENUE 300 POTOMAC, MD 20854 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $989 | $1K | $2K | 8.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATION | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE RSAA HARTFORD, CT 06156 | $598K |
| CBIZ BENEFITS & INSURANCE SERVICES EIN 31-1582098 ADMIN SUPPORT SERVICES | Plan Administrator; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 14 | 175 S MAIN STREET SUITE 720 SALT LAKE CITY, UT 84111 | $162K |
| UPMC BENEFIT MANAGEMENT SERVICES EIN 25-1769564 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 600 GRANT STREET PITTSBURGH, PA 15219 | $106K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS PROCESSING | Participant communication; Named fiduciary; Float revenue; Claims processing; Contract Administrator; Direct payment from the plan; Other services; Non-monetary compensation Service code 12 | 111 S CALVERT ST SUITE 1600 BALTIMORE, MD 21202 | $52K |
| FRYE & COMPANY, CPAS EIN 45-4199441 PLAN AUDITOR | Accounting (including auditing) Service code 10 | 9161 LIBERIA AVENUE SUITE 304 MANASSAS, VA 20110 | $34K |
| AETNA BEHAVIORAL HEALTH, LLC EIN 06-6033492 CONTRACT ADMINISTRATION | Contract Administrator Service code 13 | 151 FARMINGTON AVE HARTFORD, CT 06156 | $19K |
| HEATLH & HUMAN RESOURCES CENTER INC EIN 33-0052273 CONTRACT ADMINISTRATION | Contract Administrator Service code 13 | 151 FARMINGTON AVE HARTFORD, CT 06156 | $0 |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 CLAIMS PROCESSING | Contract Administrator Service code 13 | 501 US HIGHWAY 22 2ND FLOOR-WEST BRIDGEWATER, NJ 08807 | $0 |
| UPMC BENEFIT MANAGEMENT EIN 25-1769564 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 600 GRANT STREET PITTSBURGH, PA 15219 | $0 |
| VISION SERVICE PLAN EIN 23-7089668 CLAIMS PROCESSING | Direct payment from the plan; Claims processing; Float revenue; Participant communication; Named fiduciary; Contract Administrator; Non-monetary compensation; Other services Service code 12 | 3333 QUALITY DR RANCHO CORDOVA, CA 95670 | $0 |
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. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(7 contracts, 4 carriers) | UPMC HEALTH PLAN | 0 | $594K |
| Dental(4 contracts, 3 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY | 0 | $214K |
| Vision(5 contracts, 4 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY | 0 | $318K |
| Prescription drug(6 contracts, 4 carriers) | UPMC HEALTH PLAN | 0 | $543K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 0 | $891K |
| Other(2 contracts) | CIGNA HEALTH & LIFE INSURANCE COMPANY | 0 | $160K |
| 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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.