| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSURED SKCG INC. | 123 MAIN STREET, 14TH FLOOR WHITE PLAINS, NY 10601 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $13K | $3K | $16K | 3.47% |
| RUSSELL J CARPENTIERI3 | 86 SHEATHER RD BEDFORD CORNERS, NY 10594 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 0.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS INC EIN 06-1475928 CONTRACT ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Other services; Other fees; Contract Administrator Service code 12 | 1351 WM HOWARD TAFT RD CINCINNATI, OH 452061721 | $103K |
| EXPRESS SCRIPTS INC EIN 31-1714795 CONTRACT ADMINISTRATOR | Float revenue; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | ONE EXPRESS WAY ST LOUIS, MO 63121 | $0 |
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 | 147 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 155 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 168 | $470K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 168 | $470K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 168 | $470K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 168 | $470K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS INC | 455 | $146K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 168 | $470K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 455 | — |
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.