| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 214 N TRYON STREET, STE 2500 CHARLOTTE, NC 28202 | RELIASTAR INSURANCE COMPANY (VOYA) | $137K | — | $137K | 11.10% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 214 N TRYON STREET, STE 2500 CHARLOTTE, NC 28202 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $31K | $14K | $45K | 7.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 | Contract Administrator; Other services; Float revenue; Claims processing; Non-monetary compensation; Named fiduciary; Participant communication; Direct payment from the plan Service code 12 | 11016 RUSHMORE DRIVE SUITE 300 CHARLOTTE, NC 28277 | $890K |
| CORPORATE CHAPLAINS EIN 56-1966466 | Contract Administrator Service code 13 | PO BOX 63107 CHARLOTTE, NC 28263 | $52K |
| WILLIS TOWERS WATSON SE EIN 56-1671375 | Consulting (general) Service code 16 | 214 N TRYON STREET, STE 2500 CHARLOTTE, NC 28202 | $37K |
| 1-800MD EIN 27-1532190 | Contract Administrator Service code 13 | 6408 BANNINGTON ROAD CHARLOTTE, NC 28226 | $18K |
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 | 986 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,002 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,120 | $616K |
| Vision | VISION SERVICE PLAN | 1,180 | $188K |
| Life insurance | RELIASTAR INSURANCE COMPANY (VOYA) | 1,210 | $1.2M |
| Short-term disability | RELIASTAR INSURANCE COMPANY (VOYA) | 1,210 | $1.2M |
| Long-term disability | RELIASTAR INSURANCE COMPANY (VOYA) | 1,210 | $1.2M |
| Other | RELIASTAR INSURANCE COMPANY (VOYA) | 1,210 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,210 | — |
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.