| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $34K | — | $34K | 3.49% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 1166 AVE. OF THE AMERICAS NEW YORK, NY 10036 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 2.89% |
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 2.16% |
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | DELTA DENTAL OF CALIFORNIA | $4K | — | $4K | 3.69% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $4K | $71 | $4K | 15.21% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | VISION SERVICE PLAN | $507 | — | $507 | 3.14% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | P.O. BOX 9465 NEW YORK, NY 10087 | VISION SERVICE PLAN | $461 | — | $461 | 2.86% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $954 | — | $954 | 10.00% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $1K | $82 | $1K | 18.04% |
| SUMITOMO LIFE INSURANCE AGENCY3 | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | DELTA DENTAL OF CALIFORNIA | $197 | — | $197 | 3.59% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH JCS INC. | 565 5TH AVE., FLOOR 5 NEW YORK, NY 10017 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $353 | — | $353 | 9.99% |
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 | 150 | 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) | 150 | 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 | 194 | $1.1M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 121 | $107K |
| Vision | VISION SERVICE PLAN | 158 | $16K |
| Life insurance(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 150 | $68K |
| Short-term disability(3 contracts, 2 carriers) | AFLAC | 150 | $45K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 150 | $19K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 194 | $1.1M |
| Other(3 contracts, 2 carriers) | AFLAC | 150 | $39K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 194 | — |
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.