| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $78K | $7K | $85K | 3.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | FIRST UNUM LIFE INSURANCE COMPANY | $15K | $0 | $15K | 10.70% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.27% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $5K | $0 | $5K | 6.90% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $369 | $0 | $369 | 4.19% |
| ANGELA MONTENEGRO3 Filed as: ANGELA MONTENEGRO AND OTHER AGENTS | 74 HILLANDALE DRIVE NEW ROCHELLE, NY 10804 | AFLAC | $163 | $0 | $163 | 1.85% |
| CARL SHELOW3 | 4 TRENT LANE NORRISTOWN, PA 19401 | AFLAC | $134 | $0 | $134 | 1.52% |
| DEBRA JILL MALONEY3 | 389 LINCOLN AVENUE PORTSMOUTH, NH 03801 | AFLAC | $125 | $0 | $125 | 1.42% |
| ANDREW J JUNIKIEWICZ JR3 Filed as: ANDREW J. JUNIKIEWICZ | 22 BROOK HOLLOW DRIVE SINKING SPRING, PA 19608 | AFLAC | $71 | $0 | $71 | 0.81% |
| VINCENT MORELLI3 | 746 5TH STREET LYNDHURST, NJ 07071 | AFLAC | $46 | $0 | $46 | 0.52% |
| DOUGLAS MEIER3 Filed as: DOUGLAS R. MEIER | 23 ROCKLEDGE TERRACE POMPTON PLAINS, NJ 07444 | AFLAC | $31 | $0 | $31 | 0.35% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | FSL NY | $881 | $0 | $881 | 10.00% |
| TRACY D GREEN3 Filed as: TRACY D. GREEN | 3010 SOUTH DAKOTA AVENUE NE WASHINGTON, DC 20018 | AFLAC | $85 | $35 | $120 | 6.23% |
| ANDREW J JUNIKIEWICZ JR3 Filed as: ANDREW J. JUNIKIEWICZ JR. | 22 BROOK HOLLOW DRIVE SINKING SPRING, PA 19608 | AFLAC | $34 | $23 | $57 | 2.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $55 | $0 | $55 | 2.85% |
| POOJA JAIN3 | 3180 YEAGER DRIVE HERDON, VA 20171 | AFLAC | $37 | $8 | $45 | 2.34% |
| DIVYA JAIN3 | 4401 FAIR LAKE COURT, SUITE 304 FAIRFAX, VA 22033 | AFLAC | $15 | $8 | $23 | 1.19% |
| DIVYA JAIN3 | 14155 NEWBROOK DRIVE, SUITE 130 CHANTILLY, VA 20151 | AFLAC | $4 | $0 | $4 | 0.21% |
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 | 155 | 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) | 155 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 220 | $2.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 139 | $73K |
| Vision | FSL NY | 179 | $9K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 155 | $137K |
| Short-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 155 | $137K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 155 | $137K |
| Prescription drug | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 220 | $2.1M |
| Other(3 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 155 | $148K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 220 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.