| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 400 MIDLAND DRIVE SUITE 300 MT. LAUREL, NJ 08054 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $62K | — | $62K | 2.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 400 MIDLAND DRIVE SUITE 300 MT. LAUREL, NJ 08054 | CIGNA HEALTH & LIFE INSURANCE COMPANY | $16K | — | $16K | 8.58% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK BLUE CROSS BLUE SHIELD EIN 23-1294723 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $1.8M |
| EXPRESS SCRIPTS EIN 22-3461740 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $446K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $273K |
| UNITED CONCORDIA COMPANIES, INC. EIN 25-1687586 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $134K |
| THE HARTFORD CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 1 GRIFFIN ROAD NORTH WINDSOR, CT 06095 | $98K |
| BUSINESSOLVER.COM, INC. EIN 42-1503807 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $80K |
| BENEFIT PLAN ADMINISTRATORS, INC. EIN 54-1419753 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $53K |
| BENEFIT COORDINATORS CORPORATION EIN 25-1453488 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $5K |
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 | 3,277 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,854 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,131 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | HIGHMARK SECURITY BLUE - HMO | 103 | $609K |
| Dental | CIGNA HEALTH & LIFE INSURANCE COMPANY | 10 | $185K |
| Vision(3 contracts, 3 carriers) | EYEMED | 6,784 | $752K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 9,008 | $2.7M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 4,215 | $607K |
| Stop-loss / reinsurancereinsurance | HIGHMARK CASUALTY INSURANCE COMPANY | 3,530 | $179K |
| Other(3 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 9,008 | $2.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,008 | — |
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."
No prospect flags tripped on this filing.