| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 4000 MIDLANTIC DRIVE MOUNT LAUREL, NJ 08054 | INDEPENDENCE BLUE CROSS | $58K | $0 | $58K | 3.67% |
| MICHAEL R ACKERMAN3 Filed as: MICHAEL QUINONES ARENAS | UNKNOWN FORT WASHINGTON, PA 19034 | TRIPLE S SALUD, INC. | $3K | $0 | $3K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $0 | $5K | 11.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.23% |
| SVETLANA ZEITLIN3 | 105 ADDIS DRIVE CHURCHVILLE, PA 18966 | AFLAC | $857 | $0 | $857 | 9.03% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $785 | $0 | $785 | 8.28% |
| LAUNCHPAD BENEFITS SOLUTIONS LLC3 | 101 WEST ELM STREET, SUITE 420 CONSHOHOCKEN, PA 19428 | AFLAC | $129 | $0 | $129 | 1.36% |
| MAYRA ADORNO SERRANO3 | 151 CALLE FEDERICO COSTAS INDUSTRIAL 3, MONJITAS, SUITE 5 SAN JUAN, PR 00918 | AFLAC | $77 | $0 | $77 | 0.81% |
| MJ INSURANCE3 Filed as: RUSSELL DAYVAULT AND VARIOUS AGENTS | 2777 MEADOWVIEW COURT TARPON SPRINGS, FL 34688 | AFLAC | $58 | $0 | $58 | 0.61% |
| JOSE A SCHIENEMAN3 Filed as: JOSE A. SCHIENEMAN | 1881 SOUTH CARRIAGE LANE CHANDLER, AZ 85286 | AFLAC | $57 | $0 | $57 | 0.60% |
| ANDREW J JUNIKIEWICZ JR3 Filed as: ANDREW J. JUNIKIEWICZ JR. | 22 BROOK HOLLOW DRIVE SINKING SPRING, PA 19608 | AFLAC | $50 | $0 | $50 | 0.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $36 | $0 | $36 | 3.02% |
| SHELLY J. CAMPO3 | PO BOX 84 GREEN LANE, PA 18054 | AFLAC | $32 | $0 | $32 | 2.68% |
| JOSE A SCHIENEMAN3 Filed as: JOSE A. SCHIENEMAN | 1881 SOUTH CARRIAGE LANE CHANDLER, AZ 85286 | AFLAC | $12 | $0 | $12 | 1.01% |
| SVETLANA ZEITLIN3 | 105 ADDIS DRIVE CHURCHVILLE, PA 18966 | AFLAC | $9 | $0 | $9 | 0.75% |
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 | 138 | 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) | 138 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | INDEPENDENCE BLUE CROSS | 207 | $1.7M |
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 238 | $98K |
| Vision(2 contracts, 2 carriers) | INDEPENDENCE BLUE CROSS | 207 | $1.6M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 138 | $44K |
| Short-term disability | AFLAC | 13 | $9K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 138 | $44K |
| Prescription drug(3 contracts, 3 carriers) | INDEPENDENCE BLUE CROSS | 207 | $1.7M |
| Other(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 138 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 238 | — |
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.