| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 10100 WEST CHARLESTON BOULEVARD SUITE 220 LAS VEGAS, NV 89135 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $93K | $0 | $93K | 4.21% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 10100 WEST CHARLESTON BOULEVARD SUITE 220 LAS VEGAS, NV 89135 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $26K | $0 | $26K | 15.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 1.60% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 801 SOUTH FIGUEROA STREET SUITE 800 LOS ANGELES, CA 90017 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | $0 | $4K | 5.00% |
| JEANNINE MACKO3 | 1616 CALLE LAS CASAS OCEANSIDE, CA 92056 | AFLAC | $647 | $39 | $686 | 5.58% |
| JEFFREY NELSON3 Filed as: JEFFREY C. NELSON | 9838 RED BAY LOOP LAND O LAKES, FL 34637 | AFLAC | $588 | $39 | $627 | 5.10% |
| MJ INSURANCE3 Filed as: OLIVIA ELLIOTT AND VARIOUS AGENTS | 2402 COURTNEY MEADOWS COURT APARTMENT 102 TAMPA, FL 33619 | AFLAC | $306 | $41 | $347 | 2.82% |
| STEPHEN SNOW3 Filed as: STEPHEN P. SNOW | 68 WINGATE ROAD HOLLISTON, MA 01746 | AFLAC | $85 | $21 | $106 | 0.86% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA, INC. | PO BOX 730054 DALLAS, TX 75373 | AFLAC | $105 | $0 | $105 | 0.85% |
| OLIVE SIMPLE BENEFIT SOLUTIONS LLC3 | 9004 BILLINGSGATE PLACE LOUISVILLE, KY 40242 | AFLAC | $44 | $2 | $46 | 0.37% |
| JAMES SMITH3 Filed as: JAMES B. SMITH | 615 ELINOR STREET CHATTANOOGA, TN 37405 | AFLAC | $41 | $0 | $41 | 0.33% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 2824 SAINT ANDREWS ROAD FAIRFIELD, CA 94534 | AFLAC | $73 | $0 | $73 | 5.33% |
| LISA A MONTEDORE3 Filed as: LISA A. MONTEDORE | 24272 CATALUNA CIRCLE MISSION VIEJO, CA 92691 | AFLAC | $47 | $0 | $47 | 3.43% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $16 | $0 | $16 | 1.17% |
| THOMAS S GENTZ3 Filed as: THOMAS S. GENTZ | 3848 CHERRY BROOK LANE MASON, OH 45040 | AFLAC | $8 | $0 | $8 | 0.58% |
| MJ INSURANCE3 Filed as: DALE IRA DAVIS AND VARIOUS AGENTS | 5892 CEDARCREEK LANE LEXINGTON, KY 40515 | AFLAC | $7 | $0 | $7 | 0.51% |
| SCOTT W BLACKSHEAR3 Filed as: SCOTT W. BLACKSHEAR | 108 ALSACE COURT PONTE VEDRA BEACH, FL 32082 | AFLAC | $3 | $0 | $3 | 0.22% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA, INC. | PO BOX 730054 DALLAS, TX 75373 | AFLAC | $2 | $0 | $2 | 0.15% |
| BENITO A ROTONDI II INC3 Filed as: BENITO A. ROTONDI II, INC. | 23 PINE RIDGE ROAD SARATOGA SPRINGS, NY 12866 | AFLAC | $9 | $0 | $9 | 1.86% |
| MICHAEL BURACK3 | 46 THREEPENCE DRIVE MELVILLE, NY 11747 | AFLAC | $7 | $0 | $7 | 1.44% |
| JACQUES P DAVID CORPORATION3 Filed as: JACQUES P. DAVID CORPORATION | 5 MONFORT DRIVE HUNTINGTON, NY 11743 | AFLAC | $5 | $0 | $5 | 1.03% |
| KENNETH C MEIER CORP3 Filed as: KENNETH C. MEIER CORPORATION | 19 MARKWOOD ROAD GARDEN CITY, NY 11530 | AFLAC | $4 | $0 | $4 | 0.82% |
| BRIAN WHITE3 | 6 COWDIN LANE CHAPPAQUA, NY 10514 | AFLAC | $1 | $0 | $1 | 0.21% |
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 | 202 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 206 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 451 | $2.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 451 | $2.2M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 451 | $2.2M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 270 | $174K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 270 | $174K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 270 | $174K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 451 | $2.3M |
| Other(4 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 270 | $188K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 451 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.