| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 702 KING FAMR BOULEVARD SUITE 210 ROCKVILLE, MD 20850 | GROUP HOSPITALIZATION MEDICAL SERVICES, INC. | — | $89K | $89K | 4.36% |
| MATHER & STROHL ADMIN SVC INC5 Filed as: MATHER AND STROHL ADMINISTRATIVE | 12404 PARK CENTRAL DRIVE SUITE 400 DALLAS, TX 75251 | GROUP HOSPITALIZATION MEDICAL SERVICES, INC. | — | $17K | $17K | 0.84% |
| 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 | $63 | $6K | 2.43% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | METROPOLITAN LIFE INSURANCE COMPANY | — | $4K | $4K | 1.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | METROPOLITAN LIFE INSURANCE COMPANY | — | $14 | $14 | 0.01% |
| 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 | $12K | $2K | $14K | 9.67% |
| BUCK GLOBAL LLC3 | 606 SOUTH OLIVE STREET 23RD FLOOR LOS ANGELES, CA 90014 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | — | $8K | 5.68% |
| JAY E. BLACK3 Filed as: JAY E BLACK | 1400 MIDHURST COURT BEL AIR, MD 21014 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | — | $7K | 14.15% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 15800 CRABBS BRANCH WAY SUITE 350 ROCKVILLE, MD 20855 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | — | $6K | 12.26% |
| 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 | — | $624 | $624 | 1.29% |
| SONIA A VIDAL-AWBREY3 | 2665 PROSPERITY AVENUE APARTMENT 113 FAIRFAX, VA 22031 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $619 | — | $619 | 1.28% |
| ANN MARIE BENT3 | 7551 ORCHID HAMMOCK DRIVE WEST PALM BEACH, FL 33412 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $619 | — | $619 | 1.28% |
| ASSUREDPARTNERS3 Filed as: MID ATLANTIC BENFITS GROUP LLC | 203 MARKET STREET SUITE 201 HAVRE DE GRACE, MD 21078 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $482 | — | $482 | 1.00% |
| MICHAEL C WALKER3 Filed as: MICHAEL WALKER | 203 MARKET STREET SUITE 201 HAVRE DE GRACE, MD 21078 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $47 | — | $47 | 0.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | NATIONAL VISION ADMINISTRATORS, L.L.C. | $1K | — | $1K | 5.00% |
| JAY E. BLACK3 Filed as: JAY E BLACK | 1400 MIDHURST COURT BEL AIR, MD 21014 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 8.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 15800 CRABBS BRANCH WAY SUITE 350 ROCKVILLE, MD 20855 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 5.93% |
| 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 | — | $116 | $116 | 0.60% |
| SONIA A VIDAL-AWBREY3 | 2665 PROSPERITY AVENUE APARTMENT 113 FAIRFAX, VA 22031 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $77 | — | $77 | 0.40% |
| ANN MARIE BENT3 | 7551 ORCHID HAMMOCK DRIVE WEST PALM BEACH, FL 33412 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $77 | — | $77 | 0.40% |
| 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 | $2K | — | $2K | 14.58% |
| 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 | — | $162 | $162 | 1.21% |
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 | 196 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 116 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 312 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GROUP HOSPITALIZATION MEDICAL SERVICES, INC. | 217 | $2.0M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 578 | $254K |
| Vision | NATIONAL VISION ADMINISTRATORS, L.L.C. | 236 | $28K |
| Life insurance(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 100 | $208K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 100 | $194K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 61 | $146K |
| Other(4 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 100 | $227K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 578 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.