| 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 | COMMUNITY INSURANCE COMPANY | $61K | — | $61K | 3.28% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC. | 93224 NETWORK PLACE SUITE 3760 CHICAGO, IL 60631 | HEALTHNOW NEW YORK, INC.DBA BLUE CROSS BLUE SHIELD OF WESTERN NEW YORK | $17K | — | $17K | 3.70% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC. | 775 YARD ST STE 200 COLUMBUS, OH 43212 | METROPOLITAN LIFE INSURANCE COMPANY | $17K | $7K | $24K | 6.84% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC | 775 YARD ST. SUITE 200 COLUMBUS, OH 43212 | MEDICAL MUTUAL | $1K | $292 | $2K | 7.96% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC. | 93245 NETWORK PL CHICAGO, IL 60673 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $790 | $6K | 28.62% |
| THOMAS C SMITH3 | 2928 FOSTER CREIGHTON DRIVE NASHVILLE, TN 37402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $174 | $2K | 8.84% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC | 93245 NETWORK PL CHICAGO, IL 60673 | UNUM LIFE INSURANCE COMPANY OF AMERICA | -$1K | -$219 | -$1K | -6.55% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF OHIO INC. | 93245 NETWORK PL CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $254 | — | $254 | 3.50% |
| THOMAS C SMITH3 Filed as: THOMAS C. SMITH | 2928 FOSTER CREIGHTON DRIVE NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $108 | — | $108 | 1.49% |
| CUSTOM BENEFITS PROGRAMS3 Filed as: CUSTOM BENEFITS PROGRAMS INC. | 891 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $141 | — | $141 | 2.50% |
| THE JAMES B OSWALD COMPANY3 Filed as: OSWALD COMPANIES | 1100 SUPERIOR AVENUE, SUITE 1500 CLEVELAND, OH 44114 | ACE AMERICAN INSURANCE COMPANY | $314 | — | $314 | 15.02% |
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 | 256 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 261 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | COMMUNITY INSURANCE COMPANY | 369 | $2.3M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 558 | $349K |
| Vision | MEDICAL MUTUAL | 127 | $20K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 558 | $349K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 558 | $349K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 558 | $349K |
| Prescription drug | HEALTHNOW NEW YORK, INC.DBA BLUE CROSS BLUE SHIELD OF WESTERN NEW YORK | 92 | $465K |
| Other(5 contracts, 4 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 558 | $383K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 558 | — |
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.