| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENNIE INSURANCE, LLC3 Filed as: BENNIE INSURANCE LLC | 700 CANAL STREET, SUITE 1 STAMFORD, CT 06902 | COMMUNITY INSURANCE COMPANY | $66K | $0 | $66K | 2.53% |
| BENEFITS NETWORK INSURANCE AGENCY3 Filed as: BENEFITS NETWORK INS. AGENCY INC. | 4555 LAKE FOREST DRIVE, SUITE 510 CINCINNATI, OH 45242 | COMMUNITY INSURANCE COMPANY | $0 | $8K | $8K | 0.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 323 WEST LAKESIDE AVENUE, SUITE 410 CLEVELAND, OH 44113 | COMMUNITY INSURANCE COMPANY | $5K | $0 | $5K | 0.21% |
| ONE80 INTERMEDIARIES INC3 Filed as: ONE80 INTERMEDIARIES INC. | 4555 LAKE FOREST DRIVE CINCINNATI, OH 45242 | COMMUNITY INSURANCE COMPANY | $0 | $5K | $5K | 0.20% |
| PROFESSIONAL GROUP PLANS INC3 Filed as: PROFESSIONAL GROUP PLANS INC. | 225 WIRELESS BOULEVARD 2ND FLOOR HAUPPAUGE, NY 11788 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $18K | $5K | $22K | 11.27% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 300 MADISON AVENUE, 28TH FLOOR NEW YORK, NY 10017 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 2.53% |
No Schedule C service providers reported on this filing.
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 | 245 | 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) | 245 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 463 | $2.6M |
| Dental | COMMUNITY INSURANCE COMPANY | 463 | $2.6M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 245 | $197K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 245 | $197K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 245 | $197K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 245 | $197K |
| Prescription drug | COMMUNITY INSURANCE COMPANY | 463 | $2.6M |
| Other(2 contracts, 2 carriers) | COMMUNITY INSURANCE COMPANY | 463 | $2.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 463 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.