| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 95287 CHICAGO, IL 60694 | HIGHMARK WESTERN AND NORTHEASTERN NEW YORK INC. | $87K | $0 | $87K | 3.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 30 CENTURY HILL RD STE 200 LATHAM, NY 12110 | STANDARD LIFE INS CO OF NY | $17K | $0 | $17K | 8.41% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 95287 CHICAGO, IL 60694 | ANTHEM LIFE AND DISABILITY INC CO | $18K | $0 | $18K | 14.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 30 CENTURY HILL RD STE 200 LATHAM, NY 12110 | STANDARD LIFE INS CO OF NY | $11K | $0 | $11K | 10.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | DELTA DENTAL OF NEW YORK | $4K | $33K | $37K | 37.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 30 CENTURY HILL RD STE 200 LATHAM, NY 12110 | STANDARD LIFE INS CO OF NY | $8K | $0 | $8K | 9.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 95287 CHICAGO, IL 60694 | ANTHEM LIFE AND DISABILITY INC CO | $2K | $0 | $2K | 2.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 30 CENTURY HILL RD STE 200 LATHAM, NY 12110 | STANDARD LIFE INS CO OF NY | $9K | $0 | $9K | 12.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 95287 CHICAGO, IL 60694 | ANTHEM LIFE AND DISABILITY INC CO | $4K | $0 | $4K | 7.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 30 CENTURY HILL RD STE 200 LATHAM, NY 12110 | STANDARD LIFE INS CO OF NY | $3K | $0 | $3K | 10.74% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | ANTHEM BLUE CROSS | $1K | $255 | $2K | 4.90% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS EIN 23-7391136 NONE | Claims processing; Float revenue; Contract Administrator; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | -$352K |
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 | 365 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 365 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HIGHMARK WESTERN AND NORTHEASTERN NEW YORK INC. | 404 | $2.8M |
| Dental | DELTA DENTAL OF NEW YORK | 434 | $97K |
| Vision | ANTHEM BLUE CROSS | 372 | $31K |
| Life insurance(2 contracts, 2 carriers) | STANDARD LIFE INS CO OF NY | 379 | $123K |
| Short-term disability(2 contracts, 2 carriers) | STANDARD LIFE INS CO OF NY | 340 | $323K |
| Long-term disability(2 contracts, 2 carriers) | STANDARD LIFE INS CO OF NY | 709 | $191K |
| Prescription drug | HIGHMARK WESTERN AND NORTHEASTERN NEW YORK INC. | 404 | $2.8M |
| Other(2 contracts) | STANDARD LIFE INS CO OF NY | 417 | $120K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 709 | — |
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.