| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 1001 LAKESIDE AVENUE E STE 1500 CLEVELAND, OH 44114 | UNITEDHEALTHCARE INSURANCE COMPANY | $35K | — | $35K | 2.30% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 775 YARD ST STE 200 COLUMBUS, OH 43212 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $697 | $697 | 0.05% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 93245 NETWORK PL CHICAGO, IL 60673 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $4K | — | $4K | 4.95% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 1001 LAKE SIDE AVENUE CLEVELAND, OH 44114 | THE PRUDENTAIL INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 15.00% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | THE PRUDENTAIL INSURANCE COMPANY OF AMERICA | — | $20 | $20 | 0.03% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 7528 AUBURN RD CONCORD, OH 44077 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $4K | $2 | $4K | 16.56% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST | 93245 NETWORK PLACE CHICAGO, IL 60673 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $788 | — | $788 | 7.94% |
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 | 105 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 212 | $1.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 95 | $80K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 181 | $10K |
| Life insurance | THE PRUDENTAIL INSURANCE COMPANY OF AMERICA | 124 | $71K |
| Long-term disability | THE PRUDENTAIL INSURANCE COMPANY OF AMERICA | 124 | $71K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 212 | $1.5M |
| Other(4 contracts, 4 carriers) | THE PRUDENTAIL INSURANCE COMPANY OF AMERICA | 124 | $97K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 212 | — |
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.