| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHNSON, MICHAEL3 | 470 PARK AVE SOUTH NEW YORK, NY 10016 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $177K | $0 | $177K | 4.35% |
| MICHAEL JOHNSON3 | 8 HILLCREST PARK RD OLD GREENWICH, CT 06870 | DELTA DENTAL OF NEW YORK | $11K | $0 | $11K | 6.00% |
| MICHAEL JOHNSON3 | 8 HILLCREST RD OLD GREENWICH, CT 06870 | EQUITABLE LIFE INSURANCE COMPANY | $19K | $0 | $19K | 15.00% |
| MICHAEL JOHNSON3 | 8 HILLCREST PARK RD OLD GREENWICH, CT 068701004 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | $0 | $8K | 13.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $81 | $81 | 0.14% |
| MICHAEL JOHNSON3 | 8 HILLCREST RD OLD GREENWICH, CT 06870 | EQUITABLE LIFE INSURANCE COMPANY | $5K | $0 | $5K | 15.00% |
| MICHAEL JOHNSON3 | 8 HILLCREST PARK RD OLD GREENWICH, CT 068701004 | VISION SERVICE PLAN | $1K | $0 | $1K | 4.64% |
| JOHNSON, MICHAEL3 | 8 HILLCREST PARK RD OLD GREENWICH, CT 06870 | SUN LIFE AND HEALTH INSURANCE COMPANY (U.S.) | $2K | $0 | $2K | 14.43% |
| MICHAEL JOHNSON3 | 8 HILLCREST PARK RD OLD GREENWICH, CT 06870 | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | $691 | $0 | $691 | 8.50% |
| JOHNSON, MICHAEL3 | 8 HILLCREST PARK ROAD OLD GREENWICH, CT 06870 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $362 | $0 | $362 | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WAGEWORKS, INC. EIN 94-3351864 NONE | Contract Administrator; Claims processing Service code 12 | — | $3K |
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 | 300 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 303 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 478 | $4.3M |
| Dental(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 478 | $4.3M |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 161 | $39K |
| Life insurance(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 265 | $104K |
| Short-term disability(3 contracts, 2 carriers) | EQUITABLE LIFE INSURANCE COMPANY | 189 | $171K |
| Long-term disability(3 contracts, 2 carriers) | EQUITABLE LIFE INSURANCE COMPANY | 189 | $171K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF VERMONT | 40 | $213K |
| Other(4 contracts, 4 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 265 | $107K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 478 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.