| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST | 200 LIBERTY STREET, 6TH FLOOR NEW YORK, NY 10281 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $79K | $0 | $79K | 3.50% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $8K | $0 | $8K | 0.37% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS. | 801 SOUTH FIGUEROA STREET SUITE 800 LOS ANGELES, CA 90017 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $0 | $998 | $998 | 0.04% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST | 200 LIBERTY STREET, 6TH FLOOR NEW YORK, NY 10281 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $703 | $6K | 9.36% |
| USI INSURANCE SERVICES LLC3 | 530 PRESTON STREET, 3RD FLOOR MERIDEN, CT 06450 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $861 | $211 | $1K | 1.55% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST | ONE WORLD FINANCIAL CENTER 6TH FLOOR NEW YORK, NY 10281 | VISION SERVICE PLAN | $999 | $0 | $999 | 7.62% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $316 | $0 | $316 | 2.41% |
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 | 167 | 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) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 277 | $2.3M |
| Dental(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 277 | $2.4M |
| Vision | VISION SERVICE PLAN | 86 | $13K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 167 | $69K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 167 | $69K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 167 | $69K |
| Prescription drug | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 277 | $2.3M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 167 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 277 | — |
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.