| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 85 CHESTNUT RIDGE ROAD MONTVALE, NJ 07645 | AETNA | $36K | $0 | $36K | 14.59% |
| SOLID BENEFIT GUIDANCE3 | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | AETNA | $8K | $0 | $8K | 3.06% |
| ANETA M DUGUID3 | 24 ALICE LN LAKE BARRINGTON, IL 60010 | UNITED HEALTHCARE | $6K | $0 | $6K | 4.21% |
| COMMISSIONS PAID3 Filed as: NO COMMISSIONS | — | DELTA DENTAL | — | — | $0 | 0.00% |
| 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 | $5K | $555 | $6K | 12.23% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | EYE MED VISION CARE | $762 | $0 | $762 | 6.45% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 85 CHESTNUT RIDGE RD MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE COMPANY | $178 | $0 | $178 | 2.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE CO | $742 | $62 | $804 | 17.71% |
| WILLIAM RESNICK3 | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $22 | $0 | $22 | 0.97% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 85 CHESTNUT RIDFE RD SUITE 214 MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE COMPANY | $390 | $32 | $422 | 33.39% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLIED BENEFIT SYSTEMS EIN 36-3086057 VENDOR | Other services; Plan Administrator; Claims processing Service code 12 | 208 SOUTH LASALLE STREET CHICAGO, IL 60640 | $25K |
| AETNA EIN 06-6033492 VENDOR | Insurance services Service code 23 | — | $21K |
| ARTHUR J GALLAGHER & CO VENDOR | Insurance brokerage commissions and fees Service code 53 | 85 CHESTNUT RIDGE RD MONTVALE, NJ 07645 | $19K |
| EXPRESS SCRIPTS EIN 22-3461740 VENDOR | Claims processing Service code 12 | — | $12K |
| SOLID BENEFIT GUIDANCE EIN 20-2532319 VENDOR | Insurance brokerage commissions and fees Service code 53 | 85 CHESTNUT RIDGE ROAD MONTVALE, NJ 07645 | $4K |
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 | 202 | 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) | 202 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE | 24 | $150K |
| Dental | DELTA DENTAL | 162 | $67K |
| Vision | EYE MED VISION CARE | 245 | $12K |
| Life insurance(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 202 | $47K |
| Short-term disability(3 contracts, 3 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 99 | $16K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 202 | $46K |
| Prescription drug | UNITED HEALTHCARE | 24 | $150K |
| Stop-loss / reinsurancereinsurance | AETNA | 133 | $246K |
| Other(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 202 | $47K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 245 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.