| 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. | $40K | $0 | $40K | 2.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 | ONE JERICHO PLAZA, SUITE 200 JERICHO, NY 11753 | FIRST UNUM LIFE INSURANCE COMPANY | $16K | $0 | $16K | 6.93% |
| FIDUCIARY INTERMEDIARY LTD3 Filed as: FIDUCIARY INTERMEDIARY, LTD | 370 LEXINGTON AVENUE, ROOM 703 NEW YORK, NY 10017 | FIRST UNUM LIFE INSURANCE COMPANY | $5K | $0 | $5K | 2.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | FIRST UNUM LIFE INSURANCE COMPANY | — | $3K | $3K | 1.16% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 7.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITEDHEALTHCARE INSURANCE COMPANY | $423 | $0 | $423 | 9.19% |
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 | 164 | 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) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | OXFORD HEALTH INSURANCE, INC. | 153 | $1.5M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 83 | $78K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 54 | $5K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 164 | $225K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 164 | $225K |
| Prescription drug | OXFORD HEALTH INSURANCE, INC. | 153 | $1.5M |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 164 | $225K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 164 | — |
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.