| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE, INC | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | OXFORD HEALTH INSURANCE, INC | $178K | $0 | $178K | 3.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE COMPANY | $37K | $3K | $41K | 14.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE COMPANY | $7K | $1K | $8K | 10.12% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE COMPANY | $7K | $65 | $7K | 11.18% |
| VAN EPPS, JAMES, H3 Filed as: VAN EPS, JAMES, H | 10930 CRABAPPLE ROAD SUITE 206 ROSWELL, GA 30075 | FIRST UNUM LIFE INSURANCE COMPANY | $3K | $16 | $3K | 5.19% |
| BLOCK, CHARLES, D3 | 648 VILLAGE PARK DRIVE UNIT 208 WILMINGTON, NC 28405 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | $84 | $2K | 3.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE COMPANY | $4K | $355 | $5K | 16.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | CONNECTICUT GENERAL LIFE INSURANCE COMPANY | $3K | $0 | $3K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 85 CHESTNUT RIDGE ROAD STE 214 MONTVALE, NJ 07645 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $252 | $0 | $252 | 6.12% |
| VAN EPPS, JAMES, H3 Filed as: VAN EPPS, JAMES H | 10930 CRABAPPLE ROAD STE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $162 | $0 | $162 | 3.93% |
| BLOCK, CHARLES, D3 Filed as: BLOCK, CHARLES D | 648 VILLAGE PARK DRIVE WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $126 | $15 | $141 | 3.42% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 VENDOR | Claims processing; Contract Administrator Service code 12 | — | $18K |
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 | 404 | 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) | 404 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | OXFORD HEALTH INSURANCE, INC | 498 | $4.8M |
| Vision | CONNECTICUT GENERAL LIFE INSURANCE COMPANY | 394 | $28K |
| Life insurance(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 382 | $305K |
| Short-term disability(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 404 | $358K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 382 | $277K |
| Prescription drug | OXFORD HEALTH INSURANCE, INC | 498 | $4.8M |
| Other(3 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 382 | $343K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 498 | — |
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.