| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BOLLINGER INC3 | 200 JEFFERSON PARK WHIPPANY, NJ 07981 | METLIFE | $307 | — | $307 | 2.43% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 3RD FLOOR 250 PARK AVENUE NEW YORK, NY 10177 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 20.94% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SEWRVICES INC | SUITE 300 400 MIDLAND DRIVE MT LAUREL, NJ 08054 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $291 | $291 | 3.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 300 MADISON AVENUE 28TH FLOOR NEW YORK, NY 10017 | THE GUARDIAN | $286 | — | $286 | 11.87% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE INC | 300 MADISON AVENUE 28TH FLOOR NEW YORK, NY 10017 | THE GUARDIAN | — | $59 | $59 | 2.45% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | GOLF ROAD ROLLING MEADOWS, IL 60008 | AETNA LIFE INSURANCE COMPANY | $156 | — | $156 | 9.85% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | GOLF ROAD ROLLING MEADOWS, IL 60008 | AETNA LIFE INSURANCE COMPANY | — | $7 | $7 | 0.44% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | HYATT LEGAL | $50 | — | $50 | 10.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 181 EAST 5600 SOUTH SUITE 240 SALT LAKE CITY, UT 84107 | HYATT LEGAL | — | $2 | $2 | 0.40% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 505 NORTH BRAND BOULEVARD 6TH FLOOR GLENDALE, CA 91203 | HYATT LEGAL | — | $1 | $1 | 0.20% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX EIN 33-0441200 PHARMACY BENEFIT MANAGEME | Claims processing; Other fees; Float revenue; Direct payment from the plan Service code 12 | — | $29K |
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 | 22 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 24 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METLIFE | 16 | $13K |
| Vision | AETNA LIFE INSURANCE COMPANY | 13 | $2K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 22 | $7K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 22 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 22 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.