| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC. | P.O. BOX 1969 NORTH MORRISTOWN, NJ 07962 | COMMUNITY INSURANCE COMPANY DBA ANTHEM BLUE CROSS AND BLUE SHIELD | $4K | — | $4K | 0.70% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC. | 200 LIBERTY STREET FLOOR 6, 1 WORLD TRADE CENTER NEW YORK, NY 102810001 | METROPOLITAN LIFE INSURANCE COMPANY | $34K | $7K | $40K | 11.18% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC | 200 LIBERTY ST 6TH FL NEW YORK, NY 10281 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | — | $5K | 6.23% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA INC | 16220 N STOTTSDALE RD STE 600 SCOTTSDALE, AZ 852541804 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $311 | $311 | 0.41% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC. | 200 LIBERTY STREET 6TH FLOOR, ONE WORLD TRADE CENTER NEW YORK, NY 10281 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $32 | $2K | 7.00% |
| SMITH, THOMAS, CHRISTOPHER3 | 2928 FOSTER CREIGHTON DRIVE NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $140 | $2K | 4.55% |
| THE JAMES B OSWALD COMPANY3 | 1100 SUPERIOR AVENUE STE. 1555 CLEVELAND, OH 44114 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $651 | $0 | $651 | 1.93% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 SERVICE PROVIDER | Other fees; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator; Other services Service code 12 | — | $331K |
| WILLIS OF NEW YORK, INC. EIN 13-3179522 BROKER | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $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 | 1,065 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,065 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY DBA ANTHEM BLUE CROSS AND BLUE SHIELD | 1,065 | $626K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 826 | $360K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 826 | $360K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 306 | $76K |
| Prescription drug | COMMUNITY INSURANCE COMPANY DBA ANTHEM BLUE CROSS AND BLUE SHIELD | 1,065 | $626K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY DBA ANTHEM BLUE CROSS AND BLUE SHIELD | 1,065 | $626K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 826 | $394K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,065 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.