| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 100 MERIDIAN CENTRE BLVD. SUITE 100 ROCHESTER, NY 14618 | EXCELLUS BLUE CROSS BLUE SHIELD | $49K | — | $49K | 2.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE INC | 26 CENTURY BOULEVARD NASHVILLE, TN 37214 | EXCELLUS BLUE CROSS BLUE SHIELD | $30K | — | $30K | 1.22% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE | 26 CENTURY BLVD STE 101 NASHVILLE, TN 37214 | DELTA DENTAL OF NEW YORK | $8K | — | $8K | 5.94% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD FL 4 ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF NEW YORK | $5K | — | $5K | 3.22% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 26 CENTURY BOULEVARD NASHVILLE, TN 37214 | DELTA DENTAL OF NEW YORK | $1K | — | $1K | 0.85% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 26 CENTURY BLVD NASHVILLE, TN 37214 | MUTUAL OF OMAHA INSURANCE COMPANY | $9K | — | $9K | 6.84% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | MUTUAL OF OMAHA INSURANCE COMPANY | $4K | — | $4K | 3.16% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 220 EMERSON PL STE 200 DAVENPORT, IA 52801 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $2K | $2K | 1.44% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 26 CENTURY BLVD NASHVILLE, TN 37214 | COMPANION LIFE INSURANCE COMPANY | $7K | — | $7K | 6.76% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC NY | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | COMPANION LIFE INSURANCE COMPANY | $3K | — | $3K | 3.24% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 220 EMERSON PL STE 200 DAVENPORT, IA 52801 | COMPANION LIFE INSURANCE COMPANY | — | $2K | $2K | 1.61% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | VISION SERVICE PLAN | $645 | — | $645 | 2.68% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE, INC. | 29982 NETWORK PL CHICAGO, IL 60673 | VISION SERVICE PLAN | $587 | — | $587 | 2.44% |
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 | 388 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 13 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 406 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 280 | $2.4M |
| Dental | DELTA DENTAL OF NEW YORK | 259 | $143K |
| Vision | VISION SERVICE PLAN | 219 | $24K |
| Life insurance(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 377 | $225K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 377 | $129K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 377 | $129K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 280 | $2.4M |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 377 | $129K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 377 | — |
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.