| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | HORIZON HEALTHCARE SERVICES, INC. | $49K | $0 | $49K | 3.22% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 3600 AMERICAN BOULEVARD WEST SUITE 500 BLOOMINGTON, MN 55431 | USABLE LIFE | $7K | $0 | $7K | 13.48% |
| HORIZON INSURANCE COMPANY3 | 3 PENN PLAZA EAST M2H NEWARK, NJ 07105 | USABLE LIFE | $0 | $4K | $4K | 9.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4000 MIDLANTIC DRIVE MOUNT LAUREL, NJ 08054 | VISION SERVICE PLAN | $837 | $0 | $837 | 5.59% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | VISION SERVICE PLAN | $92 | $0 | $92 | 0.61% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $160 | $0 | $160 | 4.10% |
| RUSSELL L. DAYVAULT3 | 2777 MEADOWVIEW COURT TARPON SPRINGS, FL 34688 | AFLAC | $77 | $0 | $77 | 1.97% |
| SJC BUSINESS SERVICES LLC3 | PO BOX 84 GREEN LANE, PA 18054 | AFLAC | $45 | $0 | $45 | 1.15% |
| SVETLANA ZEITLIN3 | 105 ADDIS DRIVE CHUCHVILLE, PA 18966 | AFLAC | $43 | $0 | $43 | 1.10% |
| EDWARD F MROWKA JR3 Filed as: EDWARD R. MROWKA JR. | 5106 TIMBER LANE SCHNECKSVILLE, PA 18078 | AFLAC | $32 | $0 | $32 | 0.82% |
| JOSE A SCHIENEMAN3 Filed as: JOSE A. SCHIENEMAN | 4515 SOUTH MCCLINTOCK DRIVE SUITE 212 TEMPE, AZ 85282 | AFLAC | $22 | $0 | $22 | 0.56% |
| JACQUELINE M EBERZ3 Filed as: JACQUELINE EBERZ AND OTHER AGENTS | 98 LAMP POST ROAD NEW BRITAIN, PA 18901 | AFLAC | $21 | $0 | $21 | 0.54% |
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 | 112 | 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) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HORIZON HEALTHCARE SERVICES, INC. | 106 | $1.5M |
| Dental | HORIZON HEALTHCARE SERVICES, INC. | 106 | $1.5M |
| Vision | VISION SERVICE PLAN | 85 | $15K |
| Life insurance | USABLE LIFE | 102 | $48K |
| Short-term disability | AFLAC | 6 | $4K |
| Long-term disability | USABLE LIFE | 102 | $48K |
| Prescription drug | HORIZON HEALTHCARE SERVICES, INC. | 106 | $1.5M |
| Other(3 contracts, 3 carriers) | USABLE LIFE | 112 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 112 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.