| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC | YARD ST SUITE 200 GRANDVIEW HEIGHTS, OH 43212 | — | — | $178 | $178 | 0.04% |
| WILLIS TOWERS WATSON US LLC4 Filed as: WILLIS OF OHIO INC. | 775 YARD ST. COLUMBUS, OH 43212 | — | $5K | — | $5K | 7.80% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE EIN 31-1440175 CONTRACT ADMINISTRATOR | Claims processing; Other fees; Other services; Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 3350 PEACH TREE RD ATLANTA, GA 30326 | $89K |
| ENI EIN 16-1285790 CONTRACT ADMINISTRATOR | Other fees; Other services Service code 49 | 1041 VESTAL PARKWAY EAST VESTAL, NY 13850 | $2K |
| WILLIS OF MASSACHUSETTS, INC EIN 34-1174529 CONSULTANT | Other commissions; Consulting fees; Insurance agents and brokers Service code 22 | THREE COPLEY PLACE STE 300 BOSTON, MA 02116 | $0 |
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 | 206 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 206 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | 140 | $67K | |
| Short-term disability | 140 | $67K | |
| Long-term disability | 140 | $67K | |
| Stop-loss / reinsurancereinsurance | 206 | $404K | |
| Other(2 contracts) | 140 | $67K | |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 206 | — |
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.