| 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 | $103K | $3K | $106K | 3.06% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC. | 200 LIBERTY ST NEW YORK, NY 10281 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 5.42% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES | PO BOX 101162 PASADENA, CA 91189 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 1.29% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $75 | $75 | 0.05% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $22K | — | $22K | 28.92% |
| 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 | 9.12% |
| MICHELLE G POLLOCK3 | 5444 OAKMONT DR PACE, FL 32571 | AFLAC | $7K | — | $7K | 27.41% |
| LEIGH ANNE WHITE3 | 2533 REDFORD DR CANTONMENT, FL 32533 | AFLAC | $2K | — | $2K | 6.52% |
| BRIAN V ANDREWS3 Filed as: BRIAN VINCENT ANDREWS | 5728 TAMARACK DR PACE, FL 32571 | AFLAC | $1K | — | $1K | 4.58% |
| 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 | 1.25% |
| ANTHONY S ALMODOVAR3 Filed as: ANTHONY R ORGERA | 35 PINELAWN RD STE 190 MELVILLE, NY 11747 | AFLAC | $15 | — | $15 | 0.06% |
| WILLIAM TYLER BRUNNER3 | 5644 CHURCHILL DOWNS CT PACE, FL 32571 | AFLAC | $14 | — | $14 | 0.05% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $5K | — | $5K | 28.29% |
| MICHELLE G POLLOCK3 | 5444 OAKMONT DR PACE, FL 32571 | AFLAC | $763 | — | $763 | 8.47% |
| BRIAN V ANDREWS3 Filed as: BRIAN VINCENT ANDREWS | 5728 TAMARACK DR PACE, FL 32571 | AFLAC | $173 | — | $173 | 1.92% |
| JESSICA MARIE MUSACCHIA3 | 8118 TREETOP LN PENSACOLA, FL 32514 | AFLAC | $142 | — | $142 | 1.58% |
| LEIGH ANNE WHITE3 | 2533 REDFORD DR CANTONMENT, FL 32533 | AFLAC | $130 | — | $130 | 1.44% |
| 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 | 0.48% |
| 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 | $1K | — | $1K | 11.97% |
| 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 | $620 | — | $620 | 7.41% |
| TARA MOELLER4 | 16282 41ST ST BECKER, MN 55308 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $194 | — | $194 | 2.32% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $777 | — | $777 | 17.21% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | $28 | $2K | 56.59% |
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 | 313 | 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) | 314 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TEXAS | 460 | $3.5M |
| Dental | BLUECROSS BLUESHIELD OF TEXAS | 460 | $3.5M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 456 | $29K |
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 313 | $167K |
| Short-term disability(6 contracts) | AFLAC | 89 | $136K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 313 | $141K |
| Prescription drug | BLUECROSS BLUESHIELD OF TEXAS | 460 | $3.5M |
| Other(7 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 313 | $282K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 460 | — |
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.