| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 4 RADNOR CORPORATE CENTER RADNOR, PA 19087 | INDEPENDENCE BLUE CROSS | $68K | $0 | $68K | 3.98% |
| MICHAEL R ACKERMAN3 Filed as: MICHAEL QUIA'ONES ARENAS | UNKNOWN FORT WASHINGTON, PA 19034 | TRIPLE-S SALUD, INC. | $7K | $0 | $7K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | UNITED CONCORDIA INSURANCE COMPANY | $6K | $0 | $6K | 7.03% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | $0 | $6K | 10.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.35% |
| MAYRA ADORNO SERRANO3 | HC 3 BOX 7572 DORADO, PR 00646 | AFLAC | $2K | $237 | $2K | 14.04% |
| JOSE A SCHIENEMAN3 Filed as: JOSE SCHIENEMAN & OTHER AGENTS | 4515 SOUTH MCCLINTOCK DRIVE SUITE 212 TEMPE, AZ 85282 | AFLAC | $840 | $38 | $878 | 6.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $762 | $0 | $762 | 5.28% |
| SVETLANA ZEITLIN3 | 105 ADDIS DRIVE CHURCHVILLE, PA 18966 | AFLAC | $570 | $90 | $660 | 4.57% |
| LUIS A. ALAMO COLON3 Filed as: LUIS ALAMO COLON | C19 CALLE 4 REPARTO SAN JOSE GURABO, PR 00778 | AFLAC | $565 | $49 | $614 | 4.26% |
| MARIA IRIZARRY GARCIA3 | 151 CALLE FEDERICO COSTAS INDUSTRIAL TRES MONJITAS, SUITE 5 SAN JUAN, PR 00918 | AFLAC | $342 | $56 | $398 | 2.76% |
| GINETTE RIVERA GARCIA3 | URB RIO PIEDRAS HEIGHTS 133 CALLE WESER 2A SAN JUAN, PR 00926 | AFLAC | $345 | $49 | $394 | 2.73% |
| SHELLY J. CAMPO3 Filed as: SHELLY CAMPO | PO BOX 84 GREEN LANE, PA 18054 | AFLAC | $133 | $29 | $162 | 18.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | AFLAC | $135 | $0 | $135 | 15.22% |
| JOSE A SCHIENEMAN3 Filed as: JOSE SCHIENEMAN | 4515 SOUTH MCCLINTOCK DRIVE SUITE 212 TEMPE, AZ 85282 | AFLAC | $35 | $6 | $41 | 4.62% |
| SVETLANA ZEITLIN3 | 105 ADDIS DRIVE CHURCHVILLE, PA 18966 | AFLAC | $34 | $6 | $40 | 4.51% |
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 | 121 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | INDEPENDENCE BLUE CROSS | 184 | $1.9M |
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 208 | $89K |
| Vision(2 contracts, 2 carriers) | INDEPENDENCE BLUE CROSS | 184 | $1.7M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 121 | $56K |
| Short-term disability | AFLAC | 29 | $14K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 121 | $56K |
| Prescription drug(2 contracts, 2 carriers) | INDEPENDENCE BLUE CROSS | 184 | $1.8M |
| Other(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 121 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 208 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.