| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 2850 GOLF RD 5TH FLOOR ROLLING MEADOWS, IL 60008 | EMPIRE HEALTHCHOICE ASSURANCE, INC | $22K | $0 | $22K | 2.12% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: COOL INSURING AGENCY INC | 784 TROY-SCHENECTADY ROAD LATHAM, NY 12110 | EMPIRE HEALTHCHOICE ASSURANCE, INC | $11K | $0 | $11K | 1.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 545 METRO PLACE SOUTH SUITE 150 DUBLIN, OH 43017 | CABOT UNDERWRITERS | $33K | $0 | $33K | 37.81% |
| CAYCOMM HOLDINGS, LLC3 | 320 BOSTON POST RD SUITE 250 DARIEN, CT 06820 | CABOT UNDERWRITERS | $9K | $0 | $9K | 10.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 2850 GOLF RD 5TH FLOOR ROLLING MEADOWS, IL 60008 | ANTHEM LIFE & DISABILITY INSURANCE CO (G0458) | $664 | $0 | $664 | 7.93% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: COOL INSURING AGENCY | 7814 TROY-SCHENECTADY ROAD LATHAM, NY 12110 | ANTHEM LIFE & DISABILITY INSURANCE CO (G0458) | $506 | $0 | $506 | 6.04% |
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 | 316 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 316 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC | 200 | $1.1M |
| Dental | EMPIRE HEALTHCHOICE ASSURANCE, INC | 11 | $1.0M |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC | 11 | $1.0M |
| Life insurance | ANTHEM LIFE & DISABILITY INSURANCE CO (G0458) | 0 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 200 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.