| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON | PO BOX 28852 NEW YORK, NY 10087 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $8K | $8K | 0.84% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DE INC | PO BOX 28852 NEW YORK, NY 10087 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 0.64% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DE INC | PO BOX 28852 NEW YORK, NY 10087 | FIRST UNUM LIFE INSURANCE | — | $125 | $125 | 0.80% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE INSURANCE COMPANY NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Other services Service code 12 | 22703 NETWORK PLACE CHICAGO, IL 60673 | $1.3M |
| HEALTH YOU LLC NONE | Other services Service code 49 | 7350 CAMPUS DRIVE SUITE 100 COLORADO SPRINGS, CO 80920 | $558K |
| UNITED STATES TREASURY NONE | Other fees Service code 99 | — | $252K |
| EXPRESS SCRIPTS INC EIN 22-3461740 NONE | Employee (plan) Service code 30 | — | $153K |
| DELTA DENTAL EIN 84-0568337 NONE | Employee (plan) Service code 30 | — | $151K |
| MERCER HEALTH & BENEFITS LLC NONE | Consulting fees Service code 70 | 1225 17TH ST SUITE 1300 DENVER, CO 80202 | $131K |
| HIGHWAY TO HEALTH INC EIN 23-2903313 NONE | Claims processing Service code 12 | — | $112K |
| TOWERS WATSON EIN 53-0181291 NONE | Consulting fees Service code 70 | — | $63K |
| VISION SERVICE PLAN EIN 06-1227840 NONE | Employee (plan) Service code 30 | — | $58K |
| RENE VICTOR HERNANDEZ NONE | Copying and duplicating Service code 36 | ONE TIERRA VISTA LAGUNA HILLS, CA 92653 | $50K |
| AETNA RESOURCES FOR LIVING NONE | Other services Service code 49 | 4300 CENTREWAY PLACE, F756 ARLINGTON, TX 76018 | $41K |
| HOLLAND & HART LLP EIN 84-0382505 NONE | Legal Service code 29 | — | $27K |
| NEW MEXICO DEPARTMENT OF HEALTH NONE | Other fees Service code 99 | 1190 ST FRANCIS DRIVE SANTA FE, NM 87502 | $18K |
| BROCK AND CO CPAS PC EIN 84-0930288 NONE | Accounting (including auditing) Service code 10 | — | $16K |
| SAINT JOSEPH HOSPITAL FOUNDATION NONE | Other fees Service code 99 | 1375 E 19TH AVE DENVER, CO 80218 | $6K |
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 | 2,992 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 14 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,006 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,301 | $1.3M |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,301 | $962K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,301 | $946K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 3,007 | $1.3M |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 4,132 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,132 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.