| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC | ONE WORLD FINANCIAL CTR FL 6 200 LIBERTY ST NEW YORK, NY 10281 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $5K | — | $5K | 4.11% |
| LEONARD ADAMS INSURANCE INC3 Filed as: LEONARD BRODSKY | 48 W. BRIDGE ST. NEW HOPE, PA 18938 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $5K | $2K | $7K | 6.42% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC | 1 WORLD FINANCIAL CTR., FL 6 NEW YORK, NY 102810001 | VISION SERVICE PLAN | $2K | — | $2K | 3.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMIN | Non-monetary compensation; Direct payment from the plan; Contract Administrator; Other services; Participant communication; Named fiduciary; Claims processing; Float revenue Service code 12 | — | $352K |
| CIGNA BEHAVIORAL HEALTH INC EIN 41-1648670 CLAIMS ADMIN | Claims processing; Participant communication; Direct payment from the plan; Contract Administrator Service code 12 | — | $14K |
| WILLIS OF NEW YORK INC BROKER | Insurance agents and brokers Service code 22 | ONE WORLD FIN CTR 200 LIBERTY ST NEW YORK, NY 10281 | $7K |
| LEONARD BRODSKY BROKER | Insurance agents and brokers Service code 22 | 48 W. BRIDGE ST. NEW HOPE, PA 18938 | $7K |
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 | 853 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 853 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 853 | $472K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 853 | $415K |
| Vision | VISION SERVICE PLAN | 450 | $46K |
| Life insurance | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 570 | $104K |
| Short-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 570 | $104K |
| Long-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 540 | $127K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 853 | $415K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 853 | $415K |
| Other(2 contracts, 2 carriers) | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 570 | $110K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 853 | — |
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.