| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | PO BOX 13784 NEWARK, NJ 071883764 | METROPOLITAN LIFE INSURANCE COMPANY | $16K | $28 | $16K | 5.81% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | C/O JP MORGAN CHASE 26 CENTURY BOULEVARD NASHVILLE, TN 372143685 | METROPOLITAN LIFE INSURANCE COMPANY | — | $5K | $5K | 1.74% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $26K | $2K | $28K | 15.90% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC | PO BOX 13784 NEWARK, NJ 07188 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $10K | — | $10K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF VIRGINIA INC | PO BOX 13784 NEWWARK, NJ 07188 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $10K | — | $10K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | $989 | $14K | 16.16% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $10K | $577 | $10K | 15.88% |
| CANDY DIETZ3 Filed as: CANDY HOSSON BURTON | — | TRIPLE S SALUD INC | $1K | — | $1K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $178 | $3K | 15.94% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX INC EIN 33-0441200 PHARMACY BENEFIT MANAGER | Direct payment from the plan; Other fees; Claims processing; Float revenue Service code 12 | — | $546K |
| UMR INC EIN 39-1995276 ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $331K |
| GOVERNMENT SERVICE CONTRACTORS EIN 11-3335620 RECORDKEEPER | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $290K |
| WILLIS TOWERS WATSON SOUTHEAST INC EIN 62-1404453 BROKER | Other commissions Service code 55 | — | $120K |
| BANK OF AMERICA EIN 94-1687665 TRUSTEE | Trustee (discretionary); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $11K |
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 | 816 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 820 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 18 | $124K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 655 | $377K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,014 | $175K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 710 | $85K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 413 | $65K |
| Prescription drug | TRIPLE S SALUD INC | 5 | $21K |
| Stop-loss / reinsurancereinsurance | UNIMERICA INSURANCE COMPANY | 330 | $404K |
| Other(5 contracts, 4 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 864 | $158K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,014 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.