| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 240 N TRYON STREET STE 2500 CHARLOTTE, NC 28282 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $145K | — | $145K | 12.97% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $242 | $242 | 0.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 240 N TRYON STREET STE 2500 CHARLOTTE, NC 28202 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $27K | $9K | $36K | 6.74% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 | Claims processing; Direct payment from the plan; Non-monetary compensation; Other services; Named fiduciary; Contract Administrator; Float revenue; Participant communication Service code 12 | 11016 RUSHMORE DRIVE SUITE 300 CHARLOTTE, NC 28277 | $765K |
| WILLIS TOWERS WATSON SOUTHEAST EIN 56-1671375 | Consulting (general) Service code 16 | 214 N TRYON STREET STE 2500 CHARLOTTE, NC 28202 | $50K |
| CORPORATE CHAPLAINS EIN 56-1966466 | Contract Administrator Service code 13 | PO BOX 63107 CHARLOTTE, NC 28263 | $41K |
| CIGN | Float revenue; Other services; Participant communication; Contract Administrator; Named fiduciary; Direct payment from the plan; Non-monetary compensation; Claims processing Service code 12 | — | $0 |
| COMPSYCH EIN 35-3739783 | Contract Administrator Service code 13 | 130E RANDOLPH STREET STE 700 CHICAGO, IL 60601 | $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 | 856 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 869 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 977 | $535K |
| Vision | VISION SERICE PLAN | 1,019 | $173K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,028 | $1.1M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,028 | $1.1M |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,028 | $1.1M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,028 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,028 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.