| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AFFINITY GROUP UNDERWRITERS3 | 4510 COX ROAD, SUITE 111 GLEN ALLEN, VA 23060 | ACE AMERICAN INSURANCE COMPANY | $26K | — | $26K | 12.50% |
| BOON ADMINISTRATIVE SERVICES3 Filed as: BOON ADMINISTRATIVE SERVICES, INC. | 6300 BRIDGEPOINT PARKWAY BUILDING 3, SUITE 500 AUSTIN, TX 78730 | ACE AMERICAN INSURANCE COMPANY | $20K | — | $20K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 220748 CHARLOTTE, NC 28222 | ACE AMERICAN INSURANCE COMPANY | $20K | — | $20K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 6100 FAIRVIEW ROAD, SUITE 1400 CHARLOTTE, NC 28210 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $14K | — | $14K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203510 DALLAS, TX 75320 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203510 DALLAS, TX 75320 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $603 | — | $603 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 6100 FAIRVIEW ROAD, 14TH FLOOR CHARLOTTE, NC 28222 | HARTFORD LIFE AND ACCIDENT | $113 | — | $113 | 15.07% |
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 | 491 | 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) | 491 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ACE AMERICAN INSURANCE COMPANY | 216 | $204K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 245 | $6K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 491 | $94K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 491 | $20K |
| Prescription drug | ACE AMERICAN INSURANCE COMPANY | 216 | $204K |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 491 | $94K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 491 | — |
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.