| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: CHERNOFF DIAMOND AND COMPANY, LLC | 725 RXR PLAZA, EAST TOWER UNIONDALE, NY 11556 | AETNA LIFE INSURANCE COMPANY | $105K | $7K | $112K | 2.16% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 250 PARK AVENUE, 3RD FLOOR NEW YORK, NY 10177 | AETNA LIFE INSURANCE COMPANY | $39K | — | $39K | 0.75% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 485 UNDERHILL BOULEVARD SYOSSET, NY 11791 | AETNA LIFE INSURANCE COMPANY | — | $115 | $115 | 0.00% |
| ACRISURE LLC3 Filed as: CHERNOFF DIAMOND AND COMPANY | 725 RXR PLAZA, EAST TOWER UNIONDALE, NY 11556 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | $9K | $15K | 6.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 250 PARK AVENUE, 3RD FLOOR NEW YORK, NY 10177 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 1.12% |
| A C EDWARDS INC.3 Filed as: EDWARDS AND COMPANY | 140 GREENE AVENUE SAYVILLE, NY 11782 | HARTFORD LIFE INSURANCE COMPANY | $8K | — | $8K | 6.69% |
| ACRISURE LLC3 Filed as: CHERNOFF DIAMOND AND COMPANY, LLC | 725 RXR PLAZA, EAST TOWER UNIONDALE, NY 11556 | NATIONAL VISION ADMINISTRATORS, LLC | $867 | — | $867 | 2.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | NATIONAL VISION ADMINISTRATORS, LLC | $619 | — | $619 | 2.08% |
| ACRISURE LLC3 Filed as: CHERNOFF DIAMOND AND COMPANY, LLC | 725 RXR PLAZA, EAST TOWER UNIONDALE, NY 11556 | MUTUAL OF OMAHA INSURANCE COMPANY | $1K | $897 | $2K | 9.82% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 250 PARK AVENUE, 3RD FLOOR NEW YORK, NY 10177 | MUTUAL OF OMAHA INSURANCE COMPANY | $936 | — | $936 | 4.29% |
| A C EDWARDS INC.3 Filed as: A. C. EDWARDS, INC. | 140 GREENE AVENUE SAYVILLE, NY 11782 | HARTFORD LIFE AND ACCIDENT | $323 | — | $323 | 15.00% |
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 | 480 | 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) | 480 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 647 | $5.2M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 322 | $226K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 634 | $30K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 480 | $347K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 88 | $22K |
| Long-term disability | HARTFORD LIFE INSURANCE COMPANY | 480 | $121K |
| Prescription drug | AETNA LIFE INSURANCE COMPANY | 647 | $5.2M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE INSURANCE COMPANY | 480 | $124K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 647 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.