| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 323 WEST LAKESIDE AVENUE, SUITE 410 CLEVELAND, OH 44113 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $116K | $0 | $116K | 3.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | FIRST UNUM LIFE INSURANCE COMPANY | $17K | $0 | $17K | 8.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $3K | $3K | 1.35% |
| NAVA BENEFITS3 | 222 PARK AVENUE SOUTH NEW YORK, NY 10003 | FIRST UNUM LIFE INSURANCE COMPANY | $133 | $0 | $133 | 0.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $5K | $0 | $5K | 5.70% |
| NAVA BENEFITS3 | 222 PARK AVENUE SOUTH NEW YORK, NY 10003 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $1K | $0 | $1K | 1.19% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AND FIN. SVCS | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 75251 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $0 | $803 | $803 | 0.85% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | FSL NY | $1K | $0 | $1K | 8.29% |
| NAVA BENEFITS3 | 222 PARK AVENUE SOUTH NEW YORK, NY 10003 | FSL NY | $104 | $0 | $104 | 0.85% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AND FIN. SVCS | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 75251 | FSL NY | $104 | $0 | $104 | 0.85% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $339 | $0 | $339 | 3.89% |
| MJ INSURANCE3 Filed as: TRACY L WILBANKS AND VARIOUS AGENTS | 68 FURNACE TRAIL GREENWOOD LAKE, NY 10925 | AFLAC | $118 | $0 | $118 | 1.35% |
| DEBRA JILL MALONEY3 | 389 LINCOLN AVENUE PORTSMOUTH, NH 03801 | AFLAC | $103 | $0 | $103 | 1.18% |
| ANDREW J JUNIKIEWICZ JR3 Filed as: ANDREW J. JUNIKIEWICZ | 22 BROOK HOLLOW DRIVE SINKING SPRING, PA 19608 | AFLAC | $76 | $0 | $76 | 0.87% |
| CARL SHELOW3 | 4 TRENT LANE NORRISTOWN, PA 19608 | AFLAC | $76 | $0 | $76 | 0.87% |
| ANGELA MONTENEGRO3 | 74 HILLANDALE DRIVE NEW ROCHELLE, NY 10804 | AFLAC | $43 | $0 | $43 | 0.49% |
| DOUGLAS MEIER3 Filed as: DOUGLAS R. MEIER | 23 ROCKLEGE TERRACE POMPTON PLAINS, NJ 07444 | AFLAC | $33 | $0 | $33 | 0.38% |
| TRACY D GREEN3 Filed as: TRACY D. GREEN | 3010 SOUTH DAKOTA AVENUE NE WASHINGTON, DC 20018 | AFLAC | $38 | $0 | $38 | 3.48% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $26 | $0 | $26 | 2.38% |
| POOJA JAIN3 | 42916 VIA VENETO WAY ASHBURN, VA 20148 | AFLAC | $20 | $0 | $20 | 1.83% |
| ANDREW J JUNIKIEWICZ JR3 Filed as: ANDREW J. JUNIKIEWICZ, JR. | 22 BROOK HOLLOW DRIVE SINKING SPRING, VA 19608 | AFLAC | $16 | $0 | $16 | 1.46% |
| DIVYA JAIN3 | 14155 NEWBROOK DRIVE, SUITE 130 CHANTILLY, VA 20151 | AFLAC | $10 | $0 | $10 | 0.91% |
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 | 177 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 179 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 257 | $3.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 169 | $94K |
| Vision | FSL NY | 214 | $12K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 177 | $186K |
| Short-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 177 | $186K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 177 | $186K |
| Prescription drug | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 257 | $3.3M |
| Other(3 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 177 | $196K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 257 | — |
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.