| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 707 STATE ROAD, SUITE 101 PRINCETON, NJ 08540 | UNITEDHEALTHCARE INSURANCE COMPANY | $30K | $0 | $30K | 2.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | UNITEDHEALTHCARE INSURANCE COMPANY | $11K | $0 | $11K | 0.78% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4000 MIDLANTIC DRIVE, SUITE 300 MOUNT LAUREL, NJ 08054 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | $0 | $2K | 0.12% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4000 MIDLANTIC DRIVE, SUITE 300 MOUNT LAUREL, NJ 08054 | HORIZON HEALTHCARE SERVICES, INC. | $5K | $0 | $5K | 4.59% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | $771 | $0 | $771 | 4.88% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | VISION SERVICE PLAN | $383 | $0 | $383 | 2.43% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $263 | $0 | $263 | 6.25% |
| MJ INSURANCE3 Filed as: JOSE SCHIENEMAN & VARIOUS AGENTS | 1881 SOUTH CARRIAGE LANE CHANDLER, AZ 85286 | AFLAC | $66 | $0 | $66 | 1.57% |
| SUZANNE DICIOCCIO3 | 933 WILLOW STREET BURLINGTON, NJ 08016 | AFLAC | $58 | $0 | $58 | 1.38% |
| RUSSELL L. DAYVAULT3 Filed as: RUSSELL DAYVAULT | 2777 MEADOWVIEW COURT TARPON SPRINGS, FL 34688 | AFLAC | $46 | $0 | $46 | 1.09% |
| SJC BUSINESS SERVICES LLC3 | PO BOX 84 GREEN LANE, PA 18054 | AFLAC | $46 | $0 | $46 | 1.09% |
| SVETLANA ZEITLIN3 | 105 ADDIS DRIVE CHURCHVILLE, PA 18966 | AFLAC | $42 | $0 | $42 | 1.00% |
| EDWARD F MROWKA JR3 Filed as: EDWARD MROWKA JR | 5106 TIMBER LANE SCHNECKSVILLE, PA 18078 | AFLAC | $32 | $0 | $32 | 0.76% |
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 | 97 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 233 | $1.4M |
| Dental | HORIZON HEALTHCARE SERVICES, INC. | 109 | $102K |
| Vision | VISION SERVICE PLAN | 82 | $16K |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 233 | $1.4M |
| Short-term disability | AFLAC | 4 | $4K |
| Long-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 233 | $1.4M |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 233 | $1.4M |
| Other(3 contracts, 3 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 233 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 233 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.