| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS | 377 OAK STREET GARDEN CITY, NY 11530 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $4K | — | $4K | 18.37% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CROSSROADS HEALTHCARE MANAGEMENT EIN 74-3064316 CLAIMS PROCESSOR | Direct payment from the plan; Claims processing Service code 12 | — | $251K |
| ROBIN MODZELEWSKI EIN 22-1736275 EMPLOYEE | Direct payment from the plan; Plan Administrator Service code 14 | — | $97K |
| MERRILL LYNCH EIN 13-5674085 CUSTODIAN | Investment management; Investment management fees paid directly by plan Service code 28 | — | $64K |
| MARIA GARATE EIN 22-1736275 EMPLOYEE | Employee (plan); Plan Administrator Service code 14 | — | $51K |
| FIRST STATE TRUST COMPANY EIN 13-3124172 CUSTODIAN | Custodial (securities); Investment management fees paid directly by plan Service code 19 | — | $37K |
| BARATZ & ASSOCIATES, P.A. EIN 22-2212404 AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $36K |
| RBC WEALTH MANAGEMENT EIN 41-1416330 ADVISOR | Investment management fees paid directly by plan; Investment management Service code 28 | — | $22K |
| JOHN HUMPHREY EIN 22-1736275 EMPLOYEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $20K |
| METS SHIRO & MCGOVERN EIN 75-3116930 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $13K |
| SUMMIT ACTURIAL SERVICES LLC EIN 20-3838633 ACTUARY | Direct payment from the plan; Actuarial Service code 11 | — | $12K |
| BANK OF AMERICA EIN 94-1687665 CUSTODIAN | Direct payment from the plan; Custodial (securities) Service code 19 | — | $10K |
| ANTHONY CUSANO EIN 22-1736275 CONSULTANT | Direct payment from the plan; Consulting (general) Service code 16 | — | $8K |
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 | 685 | 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) | 685 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 772 | $21K |
| Stop-loss / reinsurancereinsurance | AMALGAMTED LIFE | 777 | $266K |
| Other | AMERICAN GENERAL LIFE INSURANCE COMPANY | 772 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 777 | — |
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.