| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE | 23 VREELAND ROAD SUITE 180 FLORHAM PARK, NJ 07932 | UNITED STATES FIRE INSURANCE COMPANY | $100K | — | $100K | 15.00% |
| BUCKINGHAM INSURANCE3 Filed as: BUCKINGHAM | 1250 BETHLEHEM PIKE HATFIELD, PA 19440 | UNITED STATES FIRE INSURANCE COMPANY | $11K | — | $11K | 1.57% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS, LLC | 1787 SENTRY PKWY W STE 320 BLUE BELL, PA 19422 | COMPANION LIFE INSURANCE COMPANY | $31K | $20K | $51K | 24.72% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS, LLC | 1787 SENTRY PKWY W STE 320 BLUE BELL, PA 19422 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS, LLC | 1787 SENTRY PKWY W STE 320 BLUE BELL, PA 19422 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $1K | $1K | 9.71% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS AND BLUE SHIELD EIN 23-7391136 NONE | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Direct payment from the plan; Contract Administrator Service code 12 | — | $680K |
| EMPLOYEES EIN 23-7218454 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $191K |
| OPTUM RX INC. EIN 33-0441200 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Other fees; Claims processing; Float revenue Service code 12 | — | $180K |
| COHEN, WEISS AND SIMON, LLP EIN 13-1592323 NONE | Legal; Direct payment from the plan Service code 29 | — | $107K |
| SAVASTA & COMPANY, INC. EIN 13-3879959 NONE | Direct payment from the plan; Consulting (general); Contract Administrator; Actuarial Service code 11 | — | $95K |
| WITHUMSMITH+BROWN, P.C. EIN 22-2027092 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $78K |
| BRIDGEWAY BENEFIT TECHNOLOGIES EIN 52-1796473 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 15 | — | $76K |
| PREMIER TECHNOLOGY SOLUTIONS, INC EIN 13-3933805 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Consulting fees; Other services Service code 15 | — | $34K |
| HORIZON ACTUARIAL SERVICES, LLC NONE | Actuarial; Consulting (general); Direct payment from the plan Service code 11 | 990 HAMMOND DRIVE SUITE 220 ATLANTA, GA 30328 | $32K |
| AMERICAN HEALTH HOLDING, INC. NONE | Direct payment from the plan; Other services Service code 49 | 7400 WEST CAMPUS ROAD F-510 NEW ALBANY, OH 43054 | $18K |
| QUADIENT FINANCE USA, INC. EIN 16-1753763 NONE | Other services; Direct payment from the plan Service code 49 | — | $15K |
| CENTRAL MOVING & STORAGE CO., INC EIN 11-2849919 NONE | Direct payment from the plan; Other services Service code 49 | — | $12K |
| QUILL NONE | Direct payment from the plan; Copying and duplicating Service code 36 | 300 TRI STATE INTERNATIONAL SUITE 300 LINCOLNSHIRE, IL 60069 | $8K |
| VERIZON EIN 23-2259884 NONE | Direct payment from the plan; Other services Service code 49 | — | $7K |
| MEDREVIEW INC EIN 13-3240352 NONE | Other services; Direct payment from the plan Service code 49 | — | $6K |
| PAUL DEMASI EIN 23-7218454 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $6K |
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 | 648 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 22 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 670 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 754 | $207K |
| Stop-loss / reinsurancereinsurance | UNITED STATES FIRE INSURANCE COMPANY | 731 | $668K |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 733 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 754 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.