| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | COM LOCKBOX 28852 PO BOX 28852 US NEW YORK, NY 100878852 | MINNESOTA LIFE INSURANCE COMPANY | — | $429K | $429K | 2.27% |
| WILLIS TOWERS WATSON US LLC7 Filed as: TOWERS WATSON DELAWARE IN | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $15K | $15K | 0.22% |
| WILLIS TOWERS WATSON US LLC7 Filed as: TOWERS WATSON DELAWARE IN | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $5K | $5K | 0.80% |
| WILLIS TOWERS WATSON US LLC7 Filed as: TOWERS WATSON DELAWARE IN | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $5 | $5 | 0.52% |
| WILLIS TOWERS WATSON US LLC7 Filed as: TOWERS WATSON DELAWARE IN | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | CIGNA LIFE INSURANCE CO. OF NEW YORK | — | $1 | $1 | 0.30% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH CARE SERVICE CORPORATION EIN 36-1236610 NONE | Contract Administrator; Claims processing Service code 12 | — | $10.5M |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 NONE | Claims processing; Contract Administrator Service code 12 | — | $1.8M |
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 NONE | Contract Administrator; Claims processing Service code 12 | — | $1.3M |
| VALUEOPTIONS, INC EIN 54-1414194 NONE | Claims processing; Contract Administrator Service code 12 | — | $981K |
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 | 23,334 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 583 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 23,917 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,479 | $415K |
| Vision | VISION SERVICE PLAN | 19,637 | $5.3M |
| Life insurance | MINNESOTA LIFE INSURANCE COMPANY | 35,155 | $18.9M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 23,334 | $6.7M |
| Other(5 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 23,334 | $4.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 35,155 | — |
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.