| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON | 780 FORSYTH BLVD SUITE 830 ST LOUIS, MO 63105 | OPTIMA HEALTH PLAN | $21K | — | $21K | 4.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC. | 200 LIBERTY ST NEW YORK, NY 10281 | UNITEDHEALTHCARE INSURANCE COMPANY | $1K | — | $1K | 0.63% |
| BB&T INS SVCS INC3 Filed as: BB AND T INS. SVCS INC. | PO BOX 168 WINSTON SALEM, NC 27102 | UNITEDHEALTHCARE INSURANCE COMPANY | $894 | — | $894 | 0.48% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC. | 1 WORLD FINANCIAL CENTER 200 LIBERTY ST, 6TH FLOOR NEW YORK, NY 10281 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $14K | $4K | $18K | 10.91% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK | 200 LIBERTY ST FL. 6 NEW YORK, NY 10281 | AETNA LIFE INSURANCE COMPANY | $3K | — | $3K | 9.94% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC. | ONE WORLD FINANCIAL CENTER 200 LIBERTY ST, 16TH FLOOR NEW YORK, NY 10281 | DELTA DENTAL OF VIRGINIA | $2K | — | $2K | 5.12% |
No Schedule C service providers reported on this filing.
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 | 372 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 379 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | OPTIMA HEALTH PLAN | 83 | $929K |
| Dental(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 83 | $66K |
| Vision | AETNA LIFE INSURANCE COMPANY | 4 | $35K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 372 | $166K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 372 | $166K |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 372 | $166K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 372 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.