| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: WALSH DUFFIELD | 801 MAIN STREET BUFFALO, NY 14205 | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | $63K | — | $63K | 4.00% |
| MARTHINSEN & SALVITTI INSURANCE GRO3 Filed as: MARTHINSEN & SALVITTI INS. GRP | 140 PARK AVE WASHINGTON, PA 15301 | UPMC HEALTH OPTIONS | $6K | — | $6K | 0.79% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW JERSEY INC. | PO BOX 416315 BOSTON, MA 02241 | AETNA LIFE INSURANCE COMPANY | $19K | — | $19K | 3.97% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF OHIO LLP | 3900 KINROSS LAKES PARKWAY 300 RICHFIELD, OH 44286 | COMMUNITY INSURANCE COMPANY | $14K | — | $14K | 3.23% |
| GEOFF LEWIS INSURANCE AGENCY LTD3 | 223 NORTHWEST AVE, SUITE 1A TALLMADGE, OH 44278 | COMMUNITY INSURANCE COMPANY | $2K | — | $2K | 0.45% |
| CALLOS RESOURCE LLC3 | 2745 S ARLINGTON RD AKRON, OH 44312 | COMMUNITY INSURANCE COMPANY | $1K | — | $1K | 0.25% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW JERSEY INC. | PO BOX 416315 BOSTON, MA 02241 | AETNA LIFE INSURANCE CO. | $5K | $2K | $7K | 6.09% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW JERSEY, INC. | PO BOX 416315 BOSTON, MA 02241 | VISION SERVICE PLAN | $794 | — | $794 | 7.06% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW JERSEY INC. | PO BOX 5002 SHORT HILLS, NJ 07078 | STANDARD INSURANCE COMPANY | $1K | — | $1K | 16.01% |
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 | 322 | 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) | 322 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 283 | $3.3M |
| Dental | AETNA LIFE INSURANCE CO. | 405 | $118K |
| Vision | VISION SERVICE PLAN | 73 | $11K |
| Long-term disability | STANDARD INSURANCE COMPANY | 15 | $7K |
| Prescription drug | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 283 | $1.6M |
| Other | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 283 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 405 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.