| 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. | $198 | — | $198 | 1.74% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Named fiduciary Service code 12 | — | $1.2M |
| CVS PHARMACY, INC EIN 05-0340626 NONE | Other services; Participant communication; Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $723K |
| BUCK GLOBAL, LLC EIN 13-3954297 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $60K |
| COHNREZNICK LLP EIN 22-1478099 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $50K |
| 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 | $24K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Direct payment from the plan; Float revenue; Shareholder servicing fees; Other fees; Trustee (directed) Service code 25 | — | $21K |
| ERNST AND YOUNG EIN 34-6565596 NONE | Direct payment from the plan; Consulting fees Service code 50 | — | $18K |
| RFN INC. MULTIMEDIA GROUP NONE | Copying and duplicating; Direct payment from the plan Service code 36 | 40 DREXEL DRIVE BAY SHORE, NY 11706 | $15K |
| CIGNA | Non-monetary compensation; Claims processing; Participant communication; Contract Administrator; Named fiduciary; Direct payment from the plan; Other services; Float revenue 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 | 4,472 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,472 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | EMBLEM HEALTH | 54 | $541K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 54 | — |
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.