| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | ONE JERICHO PLACE, SUITE 200 JERICHO, NY 11753 | HIP HEALTH PLAN OF NY | $71K | — | $71K | 3.85% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | AETNA LIFE INSURANCE COMPANY | $12K | $737 | $12K | 4.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 377 OAK STREET GARDEN CITY, NY 11530 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $9K | — | $9K | 4.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | EMPIRE HEALTHCHOICE HMO, INC. | $12K | — | $12K | 7.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 400 MIDLAND DRIVE, SUITE 300 MOUNT LAUREL, NJ 08054 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 2.26% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $100 | $100 | 0.13% |
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 | 311 | 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) | 311 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HIP HEALTH PLAN OF NY | 281 | $2.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 221 | $188K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 305 | $79K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 305 | $79K |
| Prescription drug(3 contracts, 3 carriers) | HIP HEALTH PLAN OF NY | 281 | $2.3M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 305 | $79K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 305 | — |
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.