| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSUR SVCS | PO BOX 101162 PASADENA, CA 91189 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $5K | $5K | 1.71% |
| MAIN STREET FINANCIAL GROUP Filed as: MAIN STREET FINANCIAL GROUP, INC | 22 NORTH TRADE STREET TRYON, NC 28782 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $3K | — | $3K | 2.47% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSUR SVCS | PO BOX 101162 PASADENA, CA 91189 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $2K | $2K | 1.82% |
| WILLIS TOWERS WATSON US LLC Filed as: WILLIS TOWERS WATSON SOUTHEAST | 12882 COLLECTIONS CENTER DR CHICAGO, IL 60693 | UNUM LIFE INSUR CO OF AMERICA | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSUR CO EIN 59-1031071 MEDICAL ADMIN | Float revenue; Direct payment from the plan; Contract Administrator; Non-monetary compensation; Other services; Named fiduciary; Participant communication; Claims processing Service code 12 | — | $394K |
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 | 1,219 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,227 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,323 | $384K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 1,035 | $126K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 466 | $289K |
| Long-term disability | UNUM LIFE INSUR CO OF AMERICA | 142 | $85K |
| Other(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 466 | $410K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,323 | — |
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."
No prospect flags tripped on this filing.