| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 545 METRO PLACE S SUITE 150 DUBLIN, OH 43017 | GROUP HOSPITALIZATION MEDICAL SERVICES, INC. | — | $38K | $38K | 1.16% |
| MATHER & STROHL ADMIN SVC INC5 Filed as: MATHER AND STROHL ADMINISTRATIVE | 12404 PARK CENTRAL DRIVE SUITE 400 DALLAS, TX 78251 | GROUP HOSPITALIZATION MEDICAL SERVICES, INC. | — | $17K | $17K | 0.51% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 702 KING FARM BOULEVARD SUITE 210 ROCKVILLE, MD 20850 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $54 | $6K | 2.44% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | METROPOLITAN LIFE INSURANCE COMPANY | — | $4K | $4K | 1.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | METROPOLITAN LIFE INSURANCE COMPANY | — | $8 | $8 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1050 CROWN POINTE SUITE 600 ATLANTA, GA 30338 | SUN LIFE ASSURANCE COMPANY OF CANADA | $9K | — | $9K | 7.48% |
| BUCK GLOBAL LLC3 | PO BOX 202617 DALLAS, TX 75320 | SUN LIFE ASSURANCE COMPANY OF CANADA | $9K | — | $9K | 6.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | $3K | $6K | 4.75% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 15800 CRABBS BRANCH WAY SUITE 350 ROCKVILLE, MD 20855 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 13.33% |
| JAY E. BLACK3 Filed as: JAY E BLACK | 1400 MIDHURST COURT BEL AIR, MD 21014 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 7.04% |
| SONIA A VIDAL-AWBREY3 | 2665 PROSPERITY AVENUE APARTMENT 113 FAIRFAX, VA 22031 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 5.28% |
| ANN MARIE BENT3 | 4812 WALTONSHIRE CIRCLE OLNEY, MD 20832 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 5.28% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 WEST GOLF ROAD 11TH FLOOR ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $456 | $456 | 1.50% |
| ASSUREDPARTNERS3 Filed as: MID ATLANTIC BENFITS GROUP LLC | 203 MARKET STREET SUITE 201 HAVRE DE GRACE, MD 21078 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $434 | — | $434 | 1.43% |
| MICHAEL C WALKER3 Filed as: MICHAEL WALKER | 203 MARKET STREET SUITE 201 HAVRE DE GRACE, MD 21078 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | NATIONAL VISION ADMINISTRATORS, L.L.C. | $1K | — | $1K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 15800 CRABBS BRANCHWAY SUITE 350 ROCKVILLE, MD 20855 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $592 | — | $592 | 3.79% |
| JAY E. BLACK3 Filed as: JAY E BLACK | 1400 MIDHURST COURT BEL AIR, MD 21014 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $345 | — | $345 | 2.21% |
| SONIA A VIDAL-AWBREY3 | 2665 PROSPERITY AVENUE APARTMENT 113 FAIRFAX, VA 22031 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $259 | — | $259 | 1.66% |
| ANN MARIE BENT3 | 4812 WALTONSHIRE CIRCLE OLNEY, MD 20832 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $259 | — | $259 | 1.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 WEST GOLF ROAD 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $60 | $60 | 0.38% |
| MID ATLANTIC BENEFITS GROUP LLC3 | 203 MARKET STREET SUITE 201 HAVRE DE GRACE, MD 21078 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13 | — | $13 | 0.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, IN | 15800 CRABBS BRCH WAY SUITE 350 ROCKVILLE, MD 20855 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 15.60% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 WEST GOLF ROAD 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $123 | $123 | 1.30% |
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 | 193 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 117 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 310 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GROUP HOSPITALIZATION MEDICAL SERVICES, INC. | 212 | $3.3M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 559 | $247K |
| Vision(2 contracts, 2 carriers) | GROUP HOSPITALIZATION MEDICAL SERVICES, INC. | 232 | $3.3M |
| Life insurance(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 310 | $167K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 310 | $157K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 310 | $127K |
| Other(3 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 310 | $152K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 559 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.