| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES INC. | 3318 W. FRIENDLY AVE, STE 400 GREENBORO, NC 27410 | AETNA | $3K | — | $3K | 8.16% |
| EMERSON REID LLC3 Filed as: EMERSON REID, LLC | 350 FIFTH AVENUE STE 3700 NEW YORK, NY 10118 | AETNA | $2K | — | $2K | 5.10% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | 2211 7TH AVE S BIRMINGHAM, AL 35233 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC | 300 SUMMERS ST, STE 650 CHARLESTON, WV 25301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $987 | $987 | 4.94% |
| MCGRIFF INSURANCE SERVICES INC3 | 2211 7TH AVE S BIRMINGHAM, AL 35233 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| MCGRIFF INSURANCE SERVICES INC3 | 300 SUMMERS ST, STE 650 CHARLESTON, WV 25301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $872 | $872 | 5.01% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC | 2211 7TH AVE S BIRGMINGHAM, AA 35233 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC | 300 SUMMERS ST, STE 650 CHARLESTON, WV 25301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $648 | $648 | 4.97% |
| WAYNE I CHRISTIE3 | 1 DOBSON RD EAST BRUNSWICK, NC 08816 | AFLAC | $2K | $218 | $2K | 25.17% |
| KEVIN J NIEDERAUER3 | 150 ALLEN RD, STE 110 BASKING RIDGE, NJ 07920 | AFLAC | $529 | $44 | $573 | 5.99% |
| JOSHUA PAUL GROUP INC3 Filed as: JOSHUA SAUNDERS | 17 OAK LN RANDOLPH, NJ 07869 | AFLAC | $296 | $44 | $340 | 3.56% |
| JOSHUA PAUL GROUP INC3 | 17 OAK LN RANDOLPH, NJ 07869 | AFLAC | $34 | $0 | $34 | 0.36% |
| MICHAEL A FORNARO3 | 271 US HWY, STE H119 FAIRFIELD, NJ 07004 | AFLAC | $6 | $0 | $6 | 0.06% |
| REY ROSTAMI3 | PO BOX 625 STOCKHOLM, NJ 07460 | AFLAC | $5 | $0 | $5 | 0.05% |
| TARA MICHELLE D AGOSTINO3 Filed as: TARA MICHELLE D ADOSTINO | 87A BOORAEM AVE JERSEY CITY, NJ 07307 | AFLAC | $5 | $0 | $5 | 0.05% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES INC. | 2211 7TH AVE S BIRMINGHAM, AL 35233 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $891 | — | $891 | 10.00% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC | 300 SUMMERS ST, STE 650 CHARLESTON, WA 25301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $515 | $515 | 5.78% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES | 115 SOUTH CENTRE STREET POTTSVILLE, PA 17901 | HIGHMARK, INC | $467 | — | $467 | 5.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK EIN 23-1294723 ADMIN | Claims processing Service code 12 | — | $31K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $16K |
| MCGRIFF INSURANCE SERVICES BROKER | Insurance agents and brokers Service code 22 | 115 SOUTH CENTRE STREET POTTSVILLE, PA 17901 | $13K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $4K |
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 | 116 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AETNA | 152 | $41K |
| Vision | HIGHMARK, INC | 139 | $8K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $13K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $20K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $17K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 97 | $213K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 152 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.