| 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 | $81K | $2K | $83K | 3.24% |
| 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 | $5K | — | $5K | 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 | 5.65% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS W INC | P.O. BOX 101162 PASADENA, CA 91189 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 2.07% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $57 | $57 | 0.05% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS* | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $7K | $111 | $8K | 15.19% |
| 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 | 11.31% |
| WILLIS TOWERS WATSON US LLC6 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 800 BOYLSTON STREET BOSTON, MA 02199 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS. COMPANY | $397 | — | $397 | 1.67% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS* | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | — | $2K | 10.49% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS* | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | — | $2K | 14.22% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS* | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $983 | — | $983 | 10.74% |
| IDENTITY THEFT CONSULTANTS LLC4 | 20480 166TH ST NW BIG LAKE, MN 55309 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $475 | — | $475 | 9.69% |
| 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 | $418 | — | $418 | 8.53% |
| TARA MOELLER4 | 16282 41ST ST BECKER, MN 55308 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $86 | — | $86 | 1.76% |
| KINGSIZED SOLUTIONS LLC4 | 120 CHIEFS WAY STE 1 PMB 244 PENSACOLA, FL 32507 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $30 | — | $30 | 0.61% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS* | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $254 | $76 | $330 | 14.58% |
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 | 297 | 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) | 299 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TEXAS | 454 | $2.6M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 239 | $121K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS. COMPANY | 488 | $24K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 295 | $111K |
| Short-term disability(5 contracts) | AFLAC | 60 | $90K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 295 | $111K |
| Prescription drug | BLUECROSS BLUESHIELD OF TEXAS | 454 | $2.6M |
| Other(7 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 295 | $206K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 488 | — |
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.