| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DBG BENEFIT SOLUTIONS3 Filed as: DBG BENEFIT SOLUTIONS, INC. | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $4K | $4K | 0.33% |
| DULEY BOLWAR & ASSOCIATES INC3 Filed as: DULEY-BOLWAR & ASSOCIATES INC. | 14805 N 73RD STREET SCOTTSDALE, AZ 85260 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $4K | — | $4K | 3.20% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY, LLC | PARK 80 WEST, PLAZA TWO 250 PEHLE AVENUE, SUITE 400 SADDLE BROOK, NJ 07663 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $4K | — | $4K | 2.67% |
| DULEY BOLWAR & ASSOCIATES INC3 Filed as: DULEY-BOLWAR & ASSOCIATES | 14805 N 73RD ST SCOTTSDALE, AZ 85260 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 12.60% |
| FNA INSURANCE SERVICES INC3 Filed as: FNA INSURANCE SERVICES INC. | 1000 WOODBURY ROAD 4TH FLOOR, SUITE 403 WOODBURY, NY 11797 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 5.00% |
| MBL BENEFITS CONSULTING CORP3 Filed as: MBL BENEFITS CONSULTING GROUP | 323 W 30TH STREET 11TH FLOOR NEW YORK, NY 10018 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $294 | — | $294 | 0.83% |
| SEE ATTACHED3 | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $276 | $3K | 11.69% |
| DULEY BOLWAR & ASSOCIATES INC3 Filed as: DULEY-BOLWAR & ASSOCIATES | 14805 N 73RD ST SCOTTSDALE, AZ 85260 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 5.69% |
| FNA INSURANCE SERVICES INC3 Filed as: FNA INSURANCE SERVICES, INC. | 1000 WOODBURY ROAD 4TH FLOOR, SUITE 403 WOODBURY, NY 11797 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $934 | $934 | 5.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY, LLC | PARK 80 WEST, PLAZA TWO 250 PEHLE AVENUE, SUITE 400 SADDLE BROOK, NJ 07663 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $434 | — | $434 | 2.32% |
| MBL BENEFITS CONSULTING CORP3 Filed as: MBL BENEFITS CONSULTING GROUP | 323 W 39TH STREET 11TH FLOOR NEW YORK, NY 10018 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $77 | — | $77 | 0.41% |
| DULEY BOLWAR & ASSOCIATES INC3 Filed as: DULEY BOLWAR & ASSOC INC. | 1480S N. 73RD STREET SCOTTSDALE, AZ 85260 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $625 | — | $625 | 5.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY, LLC | PARK 80 WEST, PLAZA TWO 250 PEHLE AVENUE, SUITE 400 SADDLE BROOK, NJ 07663 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $560 | — | $560 | 4.48% |
| DULEY BOLWAR & ASSOCIATES INC3 Filed as: DULEY-BOLWAR & ASSOCIATES | 14805 N 73RD ST SCOTTSDALE, AZ 85260 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $429 | — | $429 | 10.00% |
| DULEY BOLWAR & ASSOCIATES INC3 Filed as: DULEY-BOLWAR & ASSOCIATES | 14805 N 73RD ST SCOTTSDALE, AZ 85260 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $267 | — | $267 | 7.57% |
| FNA INSURANCE SERVICES INC3 Filed as: FNA INSURANCE SERVICES INC. | 1000 WOODBURY ROAD 4TH FLOOR, SUITE 403 WOODBURY, NY 11797 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $176 | $176 | 4.99% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY, LLC | PARK 80 WEST, PLAZA TWO 250 PEHLE AVENUE, SUITE 400 SADDLE BROOK, NJ 07663 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $134 | — | $134 | 3.80% |
| MBL BENEFITS CONSULTING CORP3 Filed as: MBL BENEFITS CONSULTING GROUP | 323 W 39TH STREET 11TH FLOOR NEW YORK, NY 10018 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $21 | — | $21 | 0.60% |
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 | 267 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 271 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 169 | $1.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 179 | $138K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 163 | $12K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 267 | $31K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 17 | $4K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 267 | $35K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 169 | $1.1M |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 267 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 267 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.