| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC Filed as: WILLIS TOWERS WATSON INS SERVICES W | PO BOX 730054 DALLAS, TX 753730054 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $13K | $13K | 1.27% |
| WILLIS TOWERS WATSON US LLC Filed as: WILLIS TOWERS WATSON INS SERVICES W | PO BOX 730054 DALLAS, TX 753730054 | VISION SERVICE PLAN | — | $2K | $2K | 2.19% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIM ADMINISTRATION | Named fiduciary; Participant communication; Direct payment from the plan; Other services; Contract Administrator; Claims processing Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $444K |
| EVERNORTH BEHAVIORAL HEALTH EIN 41-1648670 TO ADMINISTER ROBSON EAP | Direct payment from the plan; Claims processing; Contract Administrator; Participant communication Service code 12 | 11095 VIKING DRIVE SUITE 350 EDEN PRAIRIE, MN 55344 | $22K |
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 | 574 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 574 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,137 | $998K |
| Vision | VISION SERVICE PLAN | 471 | $79K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 955 | $213K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,137 | $998K |
| Other | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,137 | $998K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,137 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.