| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | ONE JERICHO PLAZA, SUITE 200 JERICHO, NY 11753 | OXFORD HEALTH INSURANCE, INC. | $31K | $0 | $31K | 2.30% |
| MAHMOUD ARJOMAND3 | 1 PENN PLAZA, SUITE 2035 NEW YORK, NY 10119 | FIRST UNUM LIFE INSURANCE COMPANY | $12K | $0 | $12K | 6.77% |
| FIDUCIARY INTERMEDIARY LTD3 Filed as: FIDUCIARY INERMEDIARY, LTD | 370 LEXINGTON AVENUE, SUITE 703 NEW YORK, NY 10017 | FIRST UNUM LIFE INSURANCE COMPANY | $4K | $0 | $4K | 2.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 | ONE JERICHO PLAZA, SUITE 200 JERICHO, NY 11753 | FIRST UNUM LIFE INSURANCE COMPANY | $1K | $0 | $1K | 0.73% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS. AND FIN. SVCS. | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 75251 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 4.86% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 4.16% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 501 FRANKLIN AVENUE GARDEN CITY, NY 11530 | UNITEDHEALTHCARE INSURANCE COMPANY | $457 | $0 | $457 | 10.00% |
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 | 168 | 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) | 168 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | OXFORD HEALTH INSURANCE, INC. | 168 | $1.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 88 | $79K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 81 | $5K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 165 | $179K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 165 | $179K |
| Prescription drug | OXFORD HEALTH INSURANCE, INC. | 168 | $1.3M |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 165 | $179K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 168 | — |
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."
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.