| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMWINS3 Filed as: AMWINS GROUP BENEFITS INC | 50 WHITECAP DR NORTH KINGSTOWN, RI 02852 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $0 | $5K | $5K | 2.00% |
| AMWINS3 Filed as: AMWINS GROUP BENEFITS INC | 50 WHITECAP DR NORTH KINGSTOWN, RI 02852 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $0 | $3K | $3K | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA EIN 23-2710210 MEDICAL CLAIMS PROCESSING | Claims processing; Insurance services; Plan Administrator Service code 12 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $314K |
| CHEIRON INC. EIN 03-4215617 CONSULTANT | Actuarial; Consulting (general) Service code 11 | 8300 GREENSBORO DRIVE TYSONS CORNER, VA 22102 | $61K |
| CIGNA EIN 59-1031071 DENTAL SERVICE PROVIDER | Account maintenance fees; Claims processing; Accounting (including auditing); Recordkeeping and information management (computing, tabulating, data processing, etc.); Insurance services Service code 10 | 900 COTTAGE GROVE ROAD BLOOM, CT 06002 | $18K |
| OPTUM CONNECTYOURCARE HEALTH SAVINGS PROCESSING | Custodial (other than securities) Service code 18 | 307 INTERNATIONAL CIRCLE HUNT VALLEY, MD 21030 | $16K |
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 | 1,146 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 27 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,173 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 843 | $131K |
| Life insurance | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 1,146 | $142K |
| Long-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 1,146 | $248K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,146 | — |
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.