| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC | 93245 NETWORK PLACE CHICAGO, IL 60673 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $108K | — | $108K | 3.39% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA INC | PO BOX 101162 PASADENA, CA 91189 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $32K | — | $32K | 1.00% |
| HATTERAS5 | 56 PARK ROAD TINTON FALLS, NJ 07724 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $5K | $5K | 0.16% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC. | 93245 NETWORK PL CHICAGO, IL 60673 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $76K | $16K | $92K | 7.25% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO-CLEVELAND | 93234 NETWORK PLACE CHICAGO, IL 60673 | EYEMED VISION CARE ON BEHALF OF THE COMBINED INSURANCE CO OF AMERICA | $4K | — | $4K | 0.75% |
| NOVELL INSURANCE LLC3 Filed as: NOVELL INSURANCE | PO BOX 270375 SAN JUAN, PR 00927 | TRIPLE-S SALUD, INC. | $10K | — | $10K | 4.63% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK | EMPLOYEE BENEFITS PRACTICE 200 LIBERTY STREET NEW YORK, NY 10281 | HARTFORD LIFE AND ACCIDENT | $3K | — | $3K | 20.00% |
| NOVELL INSURANCE LLC3 Filed as: NOVELL INSURANCE, LLC | PO BOX 270375 SAN JUAN, PR 00927 | DELTA DENTAL OF PUERTO RICO, INC. | $1K | — | $1K | 9.99% |
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 | 10,634 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 10,634 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TRIPLE-S SALUD, INC. | 32 | $298K |
| Dental(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 33 | $97K |
| Vision(2 contracts, 2 carriers) | EYEMED VISION CARE ON BEHALF OF THE COMBINED INSURANCE CO OF AMERICA | 11,485 | $628K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 11,660 | $3.2M |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 6,865 | $1.3M |
| Prescription drug | TRIPLE-S SALUD, INC. | 32 | $212K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 11,660 | $3.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 11,660 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.