| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 4 RADNOR CORPORATE CENTER RADNOR, PA 19087 | INDEPENDENCE BLUE CROSS | $77K | $0 | $77K | 3.98% |
| MICHAEL R ACKERMAN3 Filed as: MICHAEL QUIA 'ONES ARENAS | UNKNOWN FORT WASHINGTON, PA 19034 | TRIPLE S SALUD, INC. | $5K | $0 | $5K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED CONCORDIA INSURANCE COMPANY | $7K | $0 | $7K | 6.23% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | $541 | $7K | 10.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | VISION SERVICE PLAN | $1K | $0 | $1K | 4.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4000 MIDLANTIC DRIVE MOUNT LAUREL, NJ 08054 | VISION SERVICE PLAN | $544 | — | $544 | 2.28% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $899 | $0 | $899 | 5.05% |
| SVETLANA ZEITLIN3 | 105 ADDIS DRIVE CHURCHVILLE, PA 18966 | AFLAC | $570 | $106 | $676 | 3.80% |
| RUSSELL L. DAYVAULT3 | 2777 MEADOWVIEW COURT TARPON SPRINGS, FL 34688 | AFLAC | $447 | $93 | $540 | 3.03% |
| MAYRA ADORNO SERRANO3 | HC 3, BOX 7572 DORADO, PR 00646 | AFLAC | $354 | $0 | $354 | 1.99% |
| MJ INSURANCE3 Filed as: MARIA I GARCIA AND VARIOUS AGENTS | 151 CALLE FEDERICO COSTAS INDUSTRIAL TRES MONJITAS, SUITE 5 SAN JUAN, PR 00918 | AFLAC | $252 | $0 | $252 | 1.42% |
| ANDREW J JUNIKIEWICZ JR3 Filed as: ANDREW J. JUNIKIEWICZ, JR. | 22 BROOK HOLLOW DRIVE SINKING SPRING, PA 19608 | AFLAC | $189 | $33 | $222 | 1.25% |
| LUIS A. ALAMO COLON3 | C19 CALLE 4 REPTO SAN JOSE REPARTO SAN JOSE GURABO, PR 00778 | AFLAC | $134 | $0 | $134 | 0.75% |
| SHELLY J. CAMPO3 | PO BOX 84 GREEN LANE, PA 18054 | AFLAC | $37 | $0 | $37 | 0.21% |
| JOSE A SCHIENEMAN3 Filed as: JOSE A. SCHIENEMAN | 4515 SOUTH MCCLINTOCK DRIVE SUITE 212 TEMPE, AZ 85282 | AFLAC | $14 | $0 | $14 | 0.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4000 MIDLANTIC DRIVE, SUITE 350 MOUNT LAUREL, NJ 08054 | AETNA LIFE INSURANCE COMPANY | $509 | $0 | $509 | 3.09% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | INDEPENDENCE BLUE CROSS | 208 | $2.0M |
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 246 | $106K |
| Vision(2 contracts, 2 carriers) | INDEPENDENCE BLUE CROSS | 208 | $1.9M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 217 | $62K |
| Short-term disability | AFLAC | 26 | $18K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 217 | $62K |
| Prescription drug(2 contracts, 2 carriers) | INDEPENDENCE BLUE CROSS | 208 | $2.0M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 217 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 246 | — |
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.