| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST - | COLUMBUS 775 YARD ST COLUMBUS, OH 43212 | HUMANA HEALTH PLAN, INC. | $33K | — | $33K | 2.79% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 93245 NETWORK PLACE CHICAGO, IL 60673 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 8.87% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA INC | C/O WILLIS SAN FRANCISCO LOCKBOX LOCKBOX 100485,BANC ONE DEPT 100485 PASADENA, CA 91189 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 3.88% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $38 | $38 | 0.08% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST | 775 YARD STREET SUITE 200 COLUMBUS, OH 43212 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 8.75% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 775 YARD STREET, SUITE 200 COLUMBUS, OH 43212 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $618 | — | $618 | 6.00% |
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 | 83 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 91 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA HEALTH PLAN, INC. | 81 | $1.2M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 79 | $32K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 82 | $10K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 97 | $48K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 97 | $48K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 97 | $48K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 97 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 97 | — |
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.