| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE, INC | P.O. BOX 28852 NEW YORK, NY 100878852 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 0.97% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN, AVE, STE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $198 | $198 | 0.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE,INC | LOCKBOX #28852 NEW YORK, NY 10087 | HARTFORD LIFE AND ACCIDENT | — | $3K | $3K | 2.65% |
| RICKEY L. REDEKER3 | 304 PENNSYLVANIA AVE, STE A IRWIN, PA 15642 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $9K | — | $9K | 11.04% |
| BUCK CONSULTANTS LLC3 Filed as: BUCK CONSULTANTS, LLC | P.O. BOX 202617 DALLAS, TX 753202617 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $93 | — | $93 | 0.12% |
| REUBEN WARNER ASSOCIATES, INC.3 | 1655 RICHMOND AVENUE STATEN ISLAND, NY 10314 | FEDERAL INSURANCE COMPANY | $2K | — | $2K | 20.00% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | 320 WEST 57TH STREET NEW YORK, NY 10019 | FEDERAL INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES LLC EIN 41-1289245 N/A | Claims processing; Other services Service code 12 | — | $588K |
| BUCK CONSULTANTS EIN 13-3954297 N/A | Actuarial Service code 11 | — | $54K |
| DEAN DORTON ALLEN FORD, PLLC EIN 27-3858252 N/A | Accounting (including auditing) Service code 10 | — | $38K |
| JP MORGAN CHASE BANK EIN 13-4994650 N/A | Contract Administrator Service code 13 | — | $20K |
| CONNECTICUT GENERAL LIFE INSURANCE EIN 06-0303370 N/A | Named fiduciary; Float revenue; Claims processing; Non-monetary compensation; Contract Administrator; Other services; Direct payment from the plan; Participant communication Service code 12 | — | $18K |
| THE HARTFORD EIN 06-0838468 N/A | Claims processing Service code 12 | — | $9K |
| HEALTH ADVOCATE EIN 23-3080019 N/A | Other services Service code 49 | — | $7K |
| KPMG EIN 13-5565207 N/A | Accounting (including auditing) Service code 10 | — | $7K |
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 | 545 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 795 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,340 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED BEHAVIORAL HEALTH, DBA OPTUM | 543 | $15K |
| Vision | EASTERN VISION SERVICE PLAN, INC. | 445 | $91K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,776 | $970K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 545 | $110K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE CO OF NY | 674 | $354K |
| Other(3 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,776 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,776 | — |
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.