| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 85 CHESTNUT RIDGE ROAD MONTVALE, NJ 07645 | CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES | $30K | $0 | $30K | 4.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE, INC | 85 CHESTNUT RIDGE ROAD MONTVALE, NJ 07645 | SHELTERPOINT LIFE INSURANCE COMPANY | $15K | $0 | $15K | 15.58% |
| SOLID BENEFIT GUIDANCE3 | 85 CHESTNUT RIDGE ROAD MONTVALE, NJ 07645 | HM LIFE COMPANY OF NY | $6K | $0 | $6K | 10.00% |
| SOLID BENEFIT GUIDANCE3 | 85 CHESTNUT RIDGE ROAD MONTVALE, NJ 07645 | UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK | $2K | $0 | $2K | 11.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERV INC | TWO PIERCE PLACE ITASCA, IL 30143 | UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK | $598 | $0 | $598 | 3.23% |
| SOLID BENEFIT GUIDANCE3 | 85 CHESTNUT RIDGE ROAD MONTVALE, NJ 07645 | UNITED HEALTHCARE INSURANCE COMPANY | $1K | $0 | $1K | 10.86% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLIED BENEFIT SYSTEMS, INC EIN 36-3086057 CLAIMS PROCESSOR | Contract Administrator Service code 13 | — | $205K |
| CIGNA EIN 59-1031071 NETWORK | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $141K |
| ARTHUR J GALLAGHER & CO. BROKER | Other commissions Service code 55 | 85 CHESTNUT RIDGE RD MONTVALE, NJ 07645 | $71K |
| SOLID BENEFIT GUIDANCE BROKER | Other commissions Service code 55 | 85 CHESTNUT RIDGE RD MONTVALE, NJ 07645 | $55K |
| AMERICAN HOLDING DISEASE MANAGEMENT | Plan Administrator Service code 14 | 7400 WEST CAMPUS F-510 NEW ALBANY, OH 43054 | $27K |
| EXPRESS SCRIPTS EIN 22-3461740 PBM | Claims processing Service code 12 | — | $15K |
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 | 1,926 | 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) | 1,926 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES | 791 | $606K |
| Vision | HM LIFE COMPANY OF NY | 622 | $63K |
| Life insurance | UNITED HEALTHCARE INSURANCE COMPANY | 365 | $11K |
| Short-term disability | SHELTERPOINT LIFE INSURANCE COMPANY | 1,926 | $96K |
| Long-term disability | UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK | 34 | $19K |
| Stop-loss / reinsurancereinsurance | STANDARD SECURITY LIFE INSURANCE COMPANY | 819 | $320K |
| Other | UNITED HEALTHCARE INSURANCE COMPANY | 365 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,926 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.