| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $68K | — | $68K | 4.71% |
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | AETNA LIFE INSURANCE COMPANY | $2K | — | $2K | 3.39% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | AETNA LIFE INSURANCE COMPANY | $1K | — | $1K | 2.29% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | VISION SERVICE PLAN | $427 | — | $427 | 3.35% |
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5RH AVE., FLOOR 5 NEW YORK, NY 10017 | VISION SERVICE PLAN | $421 | — | $421 | 3.30% |
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | COMPANION LIFE INSURANCE COMPANY | $562 | — | $562 | 5.23% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | COMPANION LIFE INSURANCE COMPANY | $513 | — | $513 | 4.77% |
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | MUTUAL OF OMAHA INSURANCE COMPANY | $807 | — | $807 | 7.60% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | MUTUAL OF OMAHA INSURANCE COMPANY | $786 | — | $786 | 7.40% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | COMPANION LIFE INSURANCE COMPANY | $692 | — | $692 | 7.64% |
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | COMPANION LIFE INSURANCE COMPANY | $666 | — | $666 | 7.36% |
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | MUTUAL OF OMAHA INSURANCE COMPANY | $642 | — | $642 | 7.68% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | MUTUAL OF OMAHA INSURANCE COMPANY | $613 | — | $613 | 7.33% |
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | MUTUAL OF OMAHA INSURANCE COMPANY | $119 | — | $119 | 5.22% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | MUTUAL OF OMAHA INSURANCE COMPANY | $109 | — | $109 | 4.78% |
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 | 106 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 244 | $1.4M |
| Dental | AETNA LIFE INSURANCE COMPANY | 113 | $62K |
| Vision | VISION SERVICE PLAN | 82 | $13K |
| Life insurance(2 contracts) | COMPANION LIFE INSURANCE COMPANY | 49 | $20K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 38 | $11K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 38 | $8K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 244 | $1.4M |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 49 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 244 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.