| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | AETNA | $42K | $0 | $42K | 17.65% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | UNITED HEALTHCARE | $5K | $638 | $5K | 3.70% |
| ANETA M DUGUID3 | 24 ALICE LN LAKE BARRINGTON, IL 60010 | UNITED HEALTHCARE | $2K | $0 | $2K | 1.17% |
| 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 | $659 | $6K | 11.49% |
| BORELLA, MATTHEW, LUKE3 | 700 KINDERKAMACK ROAD SUITE 205 ORADELL, NJ 07675 | FIRST UNUM LIFE INSURANCE COMPANY | $5K | $0 | $5K | 20.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 85 CHESTNUT RIDGE RD SUITE 214 MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE COMPANY | $3K | $0 | $3K | 14.17% |
| 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 | $3K | $510 | $4K | 17.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | EYE MED VISION CARE | $2K | $0 | $2K | 12.20% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE CO | $917 | $76 | $993 | 15.23% |
| 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 | $262 | $17 | $279 | 8.10% |
| BORELLA, MATTHEW, LUKE3 | 700 KINDERKAMACK ROAD ORADELL, NJ 07675 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $187 | $0 | $187 | 5.43% |
| WILLIAM RESNICK3 | 85 CHESTNUT RIDGE ROAD SUITE 214 MONTVALE, NJ 07645 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $31 | $0 | $31 | 0.90% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLIED BENEFIT SYSTEMS EIN 36-3086057 VENDOR | Plan Administrator; Claims processing; Other services Service code 12 | 208 SOUTH LASALLE STREET CHICAGO, IL 60640 | $23K |
| AETNA EIN 06-6033492 VENDOR | Insurance services Service code 23 | — | $22K |
| GALLAGHER BENEFIT SERVICES INC. VENDOR | Insurance brokerage commissions and fees Service code 53 | 85 CHESTNUT RIDGE RD SUITE 214 MONTVALE, NJ 07645 | $22K |
| EXPRESS SCRIPTS EIN 22-3461740 VENDOR | Claims processing Service code 12 | — | $13K |
| DELTA DENTAL EIN 11-1980218 VENDOR | Contract Administrator; Claims processing Service code 12 | — | $6K |
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 | 204 | 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) | 204 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE | 23 | $143K |
| Vision | EYE MED VISION CARE | 221 | $14K |
| Life insurance(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 204 | $75K |
| Short-term disability(3 contracts, 3 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 101 | $34K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 204 | $53K |
| Prescription drug | UNITED HEALTHCARE | 23 | $143K |
| Stop-loss / reinsurancereinsurance | AETNA | 128 | $236K |
| Other(4 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 204 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 221 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.