| 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 | $78K | — | $78K | 3.06% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 200 LIBERTY STREET NEW YORK, NY 10281 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 4.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC. | 200 LIBERTY ST NEW YORK, NY 10281 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 5.86% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS. SVCS OF CA INC. | C/O WILLIS SAN FRNCSCO LCKBX 100485 BANC ONE DEPT 100485 PASADENA, CA 91189 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $5K | $5K | 4.88% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $52 | $52 | 0.05% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $10 | $10 | 0.01% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS* | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $5K | $363 | $5K | 13.59% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 1 WORLD FINANCIAL CTR 200 LIBERTY ST, 6TH FL. NEW YORK, NY 10281 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS. COMPANY | $3K | — | $3K | 11.73% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS* | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | $212 | $3K | 15.39% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS* | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $1K | $170 | $1K | 14.30% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS* | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $905 | $35 | $940 | 10.39% |
| IDENTITY THEFT CONSULTANTS LLC4 | 20480 166TH ST NW BIG LAKE, MN 55309 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $596 | — | $596 | 11.50% |
| 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 | $491 | — | $491 | 9.48% |
| TARA MOELLER4 | 16282 41ST ST BECKER, MN 55308 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $95 | — | $95 | 1.83% |
| KINGSIZED SOLUTIONS LLC4 | 120 CHIEFS WAY STE 1 PMB 244 PENSACOLA, FL 32507 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $42 | — | $42 | 0.81% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS* | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | $133 | $2K | 34.07% |
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 | 300 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 301 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TEXAS | 447 | $2.6M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 231 | $109K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS. COMPANY | 464 | $25K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 299 | $106K |
| Short-term disability(5 contracts) | AFLAC | 48 | $81K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 299 | $106K |
| Prescription drug | BLUECROSS BLUESHIELD OF TEXAS | 447 | $2.6M |
| Other(7 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 299 | $192K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 464 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.