| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC | PO BOX 601478 CHARLOTTE, NC 28260 | STANDARD INSURANCE COMPANY | $23K | — | $23K | 4.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 600 HIGHWAY 169 SOUTH, 1200 ST. LOUIS, MN 55426 | EYEMED VISION CARE/COMBINED INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 7.22% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: RUTHERFOORD | PO BOX 12748 ROANOKE, VA 23218 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $496 | $33 | $529 | 16.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 10 S WACKER DRIVE FL 17 CHICAGO, TX 60606 | PRINCIPAL LIFE INSURANCE COMPANY | — | $5K | $5K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 NONE | Participant communication; Named fiduciary; Claims processing; Float revenue; Non-monetary compensation; Contract Administrator; Direct payment from the plan; Other services Service code 12 | 3130 CHAPARRELL DRIVE, ST ROANOKE, VA 24018 | $890K |
| DELTA DENTAL OF VIRGINIA EIN 54-0844477 NONE | Contract Administrator Service code 13 | 4818 STARKEY ROAD ROANOKE, VA 24018 | $76K |
| DISCOVERY BENEFITS EIN 90-0058554 NONE | Claims processing Service code 12 | 4321 20TH AVE SW FARGO, ND 58103 | $44K |
| UNICARE/ANTHEM EMPLOYEE ASSISTANCE EIN 52-0913817 NONE | Other services; Contract Administrator Service code 13 | 4825 MARK CENTER DR ALEXANDRIA, VA 22311 | $40K |
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 | 2,961 | 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) | 2,961 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE/COMBINED INSURANCE COMPANY OF AMERICA | 1,787 | $106K |
| Life insurance | STANDARD INSURANCE COMPANY | 1,698 | $521K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 0 | $0 |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 0 | $0 |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 4,400 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,400 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.