| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | ANTHEM BLUE CROSS (G1921) | $2K | $335 | $3K | — |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | ANTHEM BLUE CROSS (G0458) | $424 | $0 | $424 | — |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 323 WEST LAKESIDE AVENUE SUITE 410 CLEAVELAND, OH 44113 | STANDARD INSURANCE COMPANY | $4K | $546 | $5K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE VANGUARD GROUP, INC. EIN 23-1945930 RECORDKEEPER | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $5K |
| RIMKUS MARCIANO AND ASSOCIATES EIN 22-2725182 TPA | Recordkeeping fees Service code 64 | 3136 SOUTH WINTON AVE SUITE 300 ROCHESTER, NY 14623 | $1K |
| ASCENSUS LLC EIN 11-3665754 RECORDKEEPER | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $0 |
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 | 106 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 28 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS (G1921) | 79 | $0 |
| Dental | ANTHEM BLUE CROSS (G1921) | 79 | $0 |
| Vision | ANTHEM BLUE CROSS (G1921) | 79 | $0 |
| Life insurance(2 contracts, 2 carriers) | ANTHEM BLUE CROSS (G0458) | 105 | $0 |
| Long-term disability(2 contracts, 2 carriers) | ANTHEM BLUE CROSS (G0458) | 105 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 105 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.