| 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 | $83K | $3K | $86K | 3.16% |
| 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 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $2K | $8K | 4.85% |
| 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 | 5.37% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | P.O. BOX 101162 PASADENA, CA 91189 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 1.74% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $60 | $60 | 0.05% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $6K | $83 | $6K | 14.65% |
| 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. | $2K | — | $2K | 8.91% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $3K | — | $3K | 18.09% |
| MICHELLE G POLLOCK3 | 5444 OAKMONT DR PACE, FL 32571 | AFLAC | $748 | — | $748 | 7.23% |
| BRIAN V ANDREWS3 | 5728 TAMARACK DR PACE, FL 32571 | AFLAC | $151 | — | $151 | 1.46% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 1 WORLD FINANCIAL CTR, FL 7 NEW YORK, NY 10281 | AFLAC | $52 | — | $52 | 0.50% |
| LEIGH ANNE WHITE3 | 2533 REDFORD DR CANTONMENT, FL 32533 | AFLAC | $50 | — | $50 | 0.48% |
| ANTHONY S ALMODOVAR3 Filed as: ANTHONY R ORGERA | 35 PINELAWN RD STE 190 MELVILLE, NY 11747 | AFLAC | $4 | — | $4 | 0.04% |
| MICHELLE G POLLOCK3 | 5444 OAKMONT DR PACE, FL 32571 | AFLAC | $596 | $11 | $607 | 7.65% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 1 WORLD FINANCIAL CTR, FL 7 NEW YORK, NY 10281 | AFLAC | $300 | — | $300 | 3.78% |
| BRIAN V ANDREWS3 | 5728 TAMARACK DR PACE, FL 32571 | AFLAC | $134 | — | $134 | 1.69% |
| ANTHONY S ALMODOVAR3 Filed as: ANTHONY R ORGERA | 35 PINELAWN RD STE 190 MELVILLE, NY 11747 | AFLAC | $14 | — | $14 | 0.18% |
| WILLIAM TYLER BRUNNER3 | 5644 CHURCHILL DOWNS CT PACE, FL 32571 | AFLAC | $11 | — | $11 | 0.14% |
| WILLIS TOWERS WATSON US LLC4 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 | $583 | — | $583 | 8.31% |
| IDENTITY THEFT CONSULTANTS LLC4 | 20480 166TH ST NW BIG LAKE, MN 55309 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $511 | — | $511 | 7.28% |
| TARA MOELLER4 | 16282 41ST ST BECKER, MN 55308 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $82 | — | $82 | 1.17% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $263 | — | $263 | 9.48% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 1 WORLD FINANCIAL CTR, FL 7 NEW YORK, NY 10281 | AFLAC | $43 | — | $43 | 4.36% |
| MICHELLE G POLLOCK3 | 5444 OAKMONT DR PACE, FL 32571 | AFLAC | $32 | — | $32 | 3.24% |
| BRIAN V ANDREWS3 | 5728 TAMARACK DR PACE, FL 32571 | AFLAC | $15 | — | $15 | 1.52% |
| WILLIAM TYLER BRUNNER3 | 5644 CHURCHILL DOWNS CT PACE, FL 32571 | AFLAC | $11 | — | $11 | 1.11% |
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 | 356 | 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) | 358 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TEXAS | 556 | $2.7M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 907 | $161K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 586 | $27K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 355 | $110K |
| Short-term disability(6 contracts) | AFLAC | 63 | $78K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 355 | $110K |
| Prescription drug | BLUECROSS BLUESHIELD OF TEXAS | 556 | $2.7M |
| Other(7 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 355 | $193K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 907 | — |
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.