| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE (RHC) | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | OXFORD HEALTH PLANS (NY), INC. | $571 | — | $571 | 2.34% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Other services; Direct payment from the plan; Contract Administrator; Participant communication; Float revenue; Named fiduciary; Non-monetary compensation; Claims processing Service code 12 | — | $1.0M |
| CVS PHARMACY, INC EIN 05-0340626 NONE | Contract Administrator; Direct payment from the plan; Claims processing; Participant communication; Other services Service code 12 | — | $681K |
| CPS OPTICAL INC. NONE | Contract Administrator; Direct payment from the plan; Claims processing; Other services Service code 12 | 11 HANOVER SQUARE 8TH FLOOR NEW YORK, NY 10005 | $83K |
| COHNREZNICK LLP EIN 22-1478099 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $50K |
| BUCK GLOBAL, LLC EIN 13-3954297 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $21K |
| ERNST AND YOUNG EIN 34-6565596 NONE | Consulting fees; Direct payment from the plan Service code 50 | — | $12K |
| RFN INC. MULTIMEDIA GROUP NONE | Copying and duplicating; Direct payment from the plan Service code 36 | 40 DREXEL DRIVE BAY SHORE, NY 11706 | $9K |
| STATE STREET BANK AND TRUST COMPANY EIN 04-1867445 NONE | Trustee (directed); Direct payment from the plan; Investment management; Other fees; Float revenue Service code 25 | — | $2K |
| CIGNA | Other services; Named fiduciary; Float revenue; Claims processing; Participant communication; Contract Administrator; Direct payment from the plan; Non-monetary compensation Service code 12 | — | $0 |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4,550 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,550 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | EMBLEM HEALTH | 53 | $399K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 53 | — |
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."
No prospect flags tripped on this filing.