| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 12505 PARK POTOMAC AVENUE SUITE 300 POTOMAC, MD 208546804 | SYMETRA LIFE INSURANCE COMPANY | — | $22K | $22K | 4.19% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 4951 LAKE BROOK DRIVE SUITE 300 GLEN ALLEN, VA 23060 | HARTFORD LIFE AND ACCIDENT | $66K | — | $66K | 16.65% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | 801 S FIGUEROA STREET SUITE 800 LOS ANGELES, CA 90017 | HARTFORD LIFE AND ACCIDENT | — | $7K | $7K | 1.75% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | PO BOX 13784 NEWARK, NJ 071883784 | METROPOLITAN LIFE INSURANCE COMPANY | $21K | $39 | $21K | 5.81% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | 26 CENTURY BLVD C/O JP MORGAN CHASE NASHVILLE, TN 372143685 | METROPOLITAN LIFE INSURANCE COMPANY | — | $6K | $6K | 1.77% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 12505 PARK POTOMAC AVENUE SUITE 300 POTOMAC, MD 208546804 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $13K | — | $13K | 9.24% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 29727 NETWORK PLACE CHICAGO, IL 60673 | HARTFORD LIFE AND ACCIDENT | $3K | $441 | $4K | 16.91% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | PO BOX 13784 NEWARK, NJ 071883784 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $39 | $4K | 18.45% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | 26 CENTURY BLVD C/O JP MORGAN CHASE NASHVILLE, TN 372143685 | METROPOLITAN LIFE INSURANCE COMPANY | — | $329 | $329 | 1.57% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | PO BOX 13784 NEWARK, NJ 071883784 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | $39 | $7K | 55.35% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | 26 CENTURY BLVD C/O JP MORGAN CHASE NASHVILLE, TN 372143685 | METROPOLITAN LIFE INSURANCE COMPANY | — | $147 | $147 | 1.12% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | PO BOX 13784 NEWARK, NJ 071883784 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $39 | $6K | 50.41% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | 26 CENTURY BLVD C/O JP MORGAN CHASE NASHVILLE, TN 372143685 | METROPOLITAN LIFE INSURANCE COMPANY | — | $114 | $114 | 1.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | PO BOX 13784 NEWARK, NJ 071883784 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | $39 | $8K | 69.52% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | 26 CENTURY BLVD C/O JP MORGAN CHASE NASHVILLE, TN 372143685 | METROPOLITAN LIFE INSURANCE COMPANY | — | $101 | $101 | 0.93% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | PO BOX 13784 NEWARK, NJ 071883784 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $39 | $6K | 76.92% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | 26 CENTURY BLVD C/O JP MORGAN CHASE NASHVILLE, TN 372143685 | METROPOLITAN LIFE INSURANCE COMPANY | — | $82 | $82 | 1.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX INC EIN 33-0441200 PHARMACY BENEFIT MANAGER | Direct payment from the plan; Claims processing; Other fees; Float revenue Service code 12 | — | $766K |
| UMR INC EIN 39-1995276 ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $419K |
| GOVERNMENT SERVICE CONTRACTORS EIN 11-3335620 RECORDKEEPER | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $404K |
| WILLIS TOWERS WATSON SOUTHEAST INC EIN 62-1404453 BROKER | Other commissions Service code 55 | — | $120K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 ADMINISTRATOR | Contract Administrator Service code 13 | — | $22K |
| BANK OF AMERICA EIN 94-1687665 TRUSTEE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Trustee (discretionary) Service code 15 | — | $11K |
| WEX EIN 06-1593514 FSA/COBRA ADMINISTRATOR | Contract Administrator Service code 13 | — | $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 | 1,396 | 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) | 1,400 | 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 | 12 | $153K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 780 | $508K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 274 | $36K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,189 | $394K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 1,189 | $394K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,189 | $394K |
| Prescription drug | TRIPLE S SALUD INC | 4 | $11K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 368 | $530K |
| Other(8 contracts, 4 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,395 | $240K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,395 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.