| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: WALSH DUFFIELD | 801 MAIN STREET BUFFALO, NY 14205 | HEALTHNOW NEW YORK, INC. | $70K | — | $70K | 4.00% |
| MARTHINSEN & SALVITTI INSURANCE GRO3 Filed as: MARTHINSEN & SALVITTI INS. GRP | 140 PARK AVE WASHINGTON, PA 15301 | UPMC HEALTH OPTIONS | $39K | — | $39K | 5.69% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW JERSEY, INC. | PO BOX 416315 BOSTON, MA 02241 | AETNA LIFE INSURANCE COMPANY | $21K | — | $21K | 3.85% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW JERSEY INC. | PO BOX 416315 BOSTON, MA 02241 | AETNA LIFE INSURANCE CO. | $3K | $4K | $7K | 5.78% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW JERSEY INC. | PO BOX 1969 MORRISTOWN, NJ 07962 | AETNA LIFE INSURANCE CO. | $2K | — | $2K | 1.99% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS. SVCS OF CA INC. | PO BOX 101162 PASADENA, CA 91189 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $67 | $67 | 0.41% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW JERSEY, INC. | PO BOX 416315 BOSTON, MA 02241 | VISION SERVICE PLAN | $711 | — | $711 | 7.71% |
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 | 413 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 414 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HEALTHNOW NEW YORK, INC. | 325 | $3.0M |
| Dental | AETNA LIFE INSURANCE CO. | 413 | $122K |
| Vision | VISION SERVICE PLAN | 65 | $9K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 15 | $16K |
| Prescription drug | HEALTHNOW NEW YORK, INC. | 325 | $1.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 413 | — |
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.