| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA | 16220 N. SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | CIGNA HEALTHCARE OF CALIFORNIA | $504 | — | $504 | 0.07% |
| WILLIS TOWERS WATSON US LLC Filed as: WILLIS OF ARIZONA | 16220 N SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | VISION SERVICE PLAN | $2K | — | $2K | 3.47% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE COMPA EIN 59-1031071 CLAIM ADMINISTRATION | Float revenue; Participant communication; Named fiduciary; Other services; Claims processing; Non-monetary compensation; Contract Administrator; Direct payment from the plan Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $324K |
| CIGNA BEHAVIORAL HEALTH EIN 41-1648670 TO ADMINISTER ROBSON EAP | Non-monetary compensation; Claims processing; Direct payment from the plan; Float revenue; Participant communication; Contract Administrator Service code 12 | 11095 VIKING DRIVE SUITE 350 EDEN PRAIRIE, MN 55344 | $21K |
| SUMMIT HEALTH | Named fiduciary; Direct payment from the plan; Contract Administrator; Other services; Participant communication; Float revenue; Non-monetary compensation; Claims processing Service code 12 | — | $1K |
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 | 465 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 465 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTHCARE OF CALIFORNIA | 73 | $743K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE CO. | 1,145 | $468K |
| Vision | VISION SERVICE PLAN | 401 | $51K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE CO. | 1,145 | $468K |
| Other | CIGNA HEALTH AND LIFE INSURANCE CO. | 1,145 | $468K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,145 | — |
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.