| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | ONE WORLD FINANCIAL CENTER 200 LIBERTY ST, 6TH FL. NEW YORK, NY 10281 | BLUECROSS BLUESHIELD OF TEXAS | $105K | $3K | $109K | 3.33% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC. | PO BOX 1969 MORRISTOWN, NJ 07962 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | $2K | $8K | 7.60% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $74 | $74 | 0.07% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $11K | $282 | $11K | 19.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 800 BOYLSTON STREET SUITE 600 BOSTON, MA 52199 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $3K | — | $3K | 9.00% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | — | $2K | 12.55% |
| MICHELLE G POLLOCK3 | 5444 OAKMONT DR PACE, FL 32571 | AFLAC | $2K | $26 | $2K | 14.67% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 1 WORLD FINANCIAL CTR, FL 7 NEW YORK, NY 10281 | AFLAC | $328 | — | $328 | 2.68% |
| BRIAN V ANDREWS3 | 5728 TAMARACK DR PACE, FL 32571 | AFLAC | $319 | $6 | $325 | 2.65% |
| LEIGH ANNE WHITE3 | 2533 REDFORD DR CANTONMENT, FL 32533 | AFLAC | $310 | — | $310 | 2.53% |
| ANTHONY S ALMODOVAR3 Filed as: ANTHONY R ORGERA | 35 PINELAWN RD STE 190 MELVILLE, NY 11747 | AFLAC | $15 | — | $15 | 0.12% |
| WILLIAM TYLER BRUNNER3 | 5644 CHURCHILL DOWNS CT PACE, FL 32571 | AFLAC | $14 | — | $14 | 0.11% |
| MICHELLE G POLLOCK3 | 5444 OAKMONT DR PACE, FL 32571 | AFLAC | $664 | — | $664 | 7.38% |
| BRIAN V ANDREWS3 | 5728 TAMARACK DR PACE, FL 32571 | AFLAC | $134 | — | $134 | 1.49% |
| LEIGH ANNE WHITE3 | 2533 REDFORD DR CANTONMENT, FL 32533 | AFLAC | $55 | — | $55 | 0.61% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 1 WORLD FINANCIAL CTR, FL 7 NEW YORK, NY 10281 | AFLAC | $48 | — | $48 | 0.53% |
| ANTHONY S ALMODOVAR3 Filed as: ANTHONY R ORGERA | 35 PINELAWN RD STE 190 MELVILLE, NY 11747 | AFLAC | $3 | — | $3 | 0.03% |
| IDENTITY THEFT CONSULTANTS LLC4 | 20480 166TH ST NW BIG LAKE, MN 55309 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $829 | — | $829 | 9.91% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | ONE WORLD FINANCIAL CENTER 200 LIBERTY ST, 6TH FL. NEW YORK, NY 10281 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $672 | — | $672 | 8.04% |
| TARA MOELLER4 | 16282 41ST ST BECKER, MN 55308 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $141 | — | $141 | 1.69% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $586 | $25 | $611 | 16.78% |
| LEIGH ANNE WHITE3 | 2533 REDFORD DR CANTONMENT, FL 32533 | AFLAC | $239 | — | $239 | 15.43% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 1 WORLD FINANCIAL CTR, FL 7 NEW YORK, NY 10281 | AFLAC | $47 | — | $47 | 3.03% |
| BRIAN V ANDREWS3 | 5728 TAMARACK DR PACE, FL 32571 | AFLAC | $47 | — | $47 | 3.03% |
| MICHELLE G POLLOCK3 | 5444 OAKMONT DR PACE, FL 32571 | AFLAC | $35 | — | $35 | 2.26% |
| WILLIAM TYLER BRUNNER3 | 5644 CHURCHILL DOWNS CT PACE, FL 32571 | AFLAC | $15 | — | $15 | 0.97% |
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 | 340 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 342 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TEXAS | 557 | $3.3M |
| Dental | BLUECROSS BLUESHIELD OF TEXAS | 557 | $3.3M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 545 | $31K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 340 | $110K |
| Short-term disability(6 contracts) | AFLAC | 89 | $97K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 340 | $110K |
| Prescription drug | BLUECROSS BLUESHIELD OF TEXAS | 557 | $3.3M |
| Other(7 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 340 | $214K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 557 | — |
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.