| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FRED MAXWELL - ACIUS GROUP3 Filed as: FRED THOMAS MAXWELL | ACIUS GROUP 2591 DALLAS PKY #203 US, TX 75034 | MINNESOTA LIFE INSURANCE COMPANY | $85K | $313K | $398K | 2.98% |
| WILLIS TOWERS WATSON US LLC7 Filed as: WILLIS TOWERS WATSON US L | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $36K | $36K | 0.66% |
| WILLIS TOWERS WATSON US LLC7 Filed as: WILLIS TOWERS WATSON US L | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 0.69% |
| WILLIS TOWERS WATSON US LLC7 Filed as: WILLIS TOWERS WATSON US L | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | CIGNA LIFE INSURANCE CO. OF NEW YORK | — | $2 | $2 | 0.16% |
| WILLIS TOWERS WATSON US LLC7 Filed as: WILLIS TOWERS WATSON US L | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3 | $3 | 0.84% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH CARE SERVICE CORPORATION EIN 36-1236610 NONE | Contract Administrator; Claims processing Service code 12 | — | $10.0M |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 NONE | Contract Administrator; Claims processing Service code 12 | — | $1.4M |
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 NONE | Contract Administrator; Non-monetary compensation; Other services; Direct payment from the plan; Claims processing; Named fiduciary; Participant communication; Float revenue Service code 12 | — | $1.2M |
| VALUEOPTIONS, INC. EIN 54-1414194 NONE | Insurance services Service code 23 | — | $887K |
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 | 26,350 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 224 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 26,574 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 3,736 | $469K |
| Vision | VISION SERVICE PLAN | 20,534 | $4.4M |
| Life insurance | MINNESOTA LIFE INSURANCE COMPANY | 36,031 | $13.3M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 26,052 | $5.5M |
| Other(5 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 43,666 | $3.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 43,666 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.