| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 10 NORTH PARK DR #200 HUNT VALLEY, MD 21030 | FIRST UNUM LIFE INSURANCE COMPANY | $5K | $204 | $5K | 10.69% |
| USI INSURANCE SERVICES LLC3 | 100 N MAIN ST WINSTON-SALEM, NC 27150 | FIRST UNUM LIFE INSURANCE COMPANY | — | $2K | $2K | 3.68% |
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 10 N PARK DR #200 HUNT VALLEY, MD 21030 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | $51 | $2K | 15.47% |
| USI INSURANCE SERVICES LLC3 | 100 N MAIN ST WINSTON-SALEM, NC 27150 | FIRST UNUM LIFE INSURANCE COMPANY | — | $194 | $194 | 1.81% |
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 200 INTERNATIONAL DR #4500 HUNT VALLEY, MD 21031 | FIRST UNUM LIFE INSURANCE COMPANY | $296 | — | $296 | 3.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | PO BOX 95287 CHICAGO, IL 60694 | FIRST UNUM LIFE INSURANCE COMPANY | $48 | — | $48 | 0.55% |
| BORELLA, MATTHEW, LUKE3 | 700 KINDERKAMACK RD #205 ORADELL, NJ 07675 | FIRST UNUM LIFE INSURANCE COMPANY | $22 | — | $22 | 0.25% |
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 10 NORTH PARK DRIVE #200 HUNT VALLEY, MD 21030 | EYEMED VISION CARE | $72 | — | $72 | 0.99% |
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 10 N PARK DR #200 HUNT VALLEY, MD 21030 | FIRST UNUM LIFE INSURANCE COMPANY | $649 | $18 | $667 | 15.41% |
| USI INSURANCE SERVICES LLC3 | 100 N MAIN ST WINSTON-SALEM, NC 27150 | FIRST UNUM LIFE INSURANCE COMPANY | — | $136 | $136 | 3.14% |
| BORELLA, MATTHEW, LUKE3 | 700 KINDERKAMACK RD #205 ORADELL, NJ 07675 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 1.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | PO BOX 95287 CHICAGO, IL 60684 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASSURED PARTNERS LLC EIN 45-3443572 BROKER | Contract Administrator; Claims processing Service code 12 | — | $38K |
| ALLIED BENEFIT SYSTEMS, LLC EIN 36-3086057 TPA ADMIN | Claims processing; Contract Administrator Service code 12 | — | $32K |
| CIGNA EIN 59-1031071 PPO ADMIN | Claims processing; Contract Administrator Service code 12 | — | $13K |
| DELTA DENTAL OF NEW YORK EIN 11-1980218 DENTAL ADMIN | Claims processing; Contract Administrator Service code 12 | — | $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 | 111 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE | 128 | $7K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 111 | $51K |
| Short-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 27 | $9K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 111 | $51K |
| Other(5 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 111 | $76K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 128 | — |
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.