| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| 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% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND | PO BOX 13784 NEWARK, NJ 07188 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $3K | — | $3K | 8.24% |
| 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% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATION | Contract Administrator Service code 13 | 155 FARMINGTON AVENUE RSAA HARTFORD, CT 06156 | $385K |
| NETWORK ADMINISTRATORS D/B/A GSA EIN 11-3335620 ADMIN SUPPORT SERVICES | Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator; Direct payment from the plan Service code 14 | 888 VETERANS MEMORIAL HWY SUITE 540 HAUPPAUGE, NY 11788 | $180K |
| AETNA BEHAVIORAL HEALTH, LLC EIN 33-0052276 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 155 FARMINGTON AVENUE RSAA HARTFORD, CT 06156 | $28K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS PROCESSING | Direct payment from the plan; Claims processing; Participant communication; Contract Administrator; Non-monetary compensation; Other services; Named fiduciary; Float revenue Service code 12 | 111 S CALVERT ST SUITE 1600 BALTIMORE, MD 21202 | $25K |
| FRYE & COMPANY, CPAS EIN 45-4199441 PLAN AUDITOR | Accounting (including auditing) Service code 10 | 9161 LIBERIA AVENUE SUITE 304 MANASSAS, VA 20110 | $19K |
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 | 987 | 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) | AETNA HEALTH & HUMAN RESOURCE CENTER | 484 | $580K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 250 | $36K |
| Vision | VISION SERVICE PLAN | 219 | $21K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $234K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $121K |
| Other | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 250 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 484 | — |
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.