| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS HRH OF NEW YORK | ONE WORLD FINANCIAL CENTER 200 LIBERTY STREET NEW YORK, NY 10281 | CAPITAL ADVANTAGE ASSURANCE COMPANY | $82K | — | $82K | 1.83% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS HRH OF NEW YORK | ONE WORLD FINANCIAL CENTER 200 LIBERTY STREET NEW YORK, NY 10281 | KEYSTONE HEALTH PLAN CENTRAL | $18K | — | $18K | 1.84% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC. | 1 WORLD FINANCIAL CENTER 200 LIBERTY STREET NEW YORK, NY 10281 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $17K | — | $17K | 5.91% |
| CRYSTAL IBC LLC3 Filed as: CRYSTAL AND COMPANY | 32 OLD SLIP NEW YORK, NY 10005 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 2.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF CALIFORNIA, INC. | PO BOX 100003 PASADENA, CA 91189 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 0.94% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK | ONE WORLD FINANCIAL CENTER 200 LIBERTY STREET NEW YORK, NY 10281 | DELTA DENTAL OF PENNSYLVANIA | $11K | — | $11K | 5.99% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC. | 1 WORLD FINANCIAL CENTER 200 LIBERTY STREET, 6TH FLOOR NEW YORK, NY 10281 | EYEMED VISION CARE | $4K | — | $4K | 8.19% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC. | 200 LIBERTY STREET, 6TH FLOOR NEW YORK, NY 10281 | ZURICH AMERICAN INSURANCE COMPANY | $775 | — | $775 | — |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CAPITAL ADVANTAGE ASSURANCE COMPANY | 660 | $5.5M |
| Dental | DELTA DENTAL OF PENNSYLVANIA | 629 | $191K |
| Vision | EYEMED VISION CARE | 653 | $49K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 810 | $288K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 810 | $288K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 810 | $288K |
| Prescription drug(2 contracts, 2 carriers) | CAPITAL ADVANTAGE ASSURANCE COMPANY | 660 | $5.5M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 830 | $288K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 830 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.