| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203510 DALLAS, TX 75320 | AETNA LIFE INSURANCE COMPANY | — | $8K | $8K | 0.27% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 1439 BLUEFIELD, WV 24701 | AETNA LIFE INSURANCE COMPANY | — | $67 | $67 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 600 HIGHWAY 169 SOUTH, 18TH FLOOR SAINT LOUIS PARK, MN 55426 | METROPOLITAN LIFE INSURANCE COMPANY | $10K | $27 | $10K | 4.78% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 1018 WEST 9TH AVENUE KING OF PRUSSIA, PA 19406 | METROPOLITAN LIFE INSURANCE COMPANY | — | $3K | $3K | 1.48% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203491 DALLAS, TX 75320 | DELTA DENTAL OF VIRGINIA | $4K | — | $4K | 2.87% |
| LARRY W OWEN3 Filed as: LARRY W. OWEN | PO BOX 783 SALEM, VA 24153 | AFLAC | $14K | $834 | $15K | 14.85% |
| KEVIN L MARTIN3 Filed as: KEVIN L. MARTIN | 608 WEST CARROLLTON AVENUE SALEM, VA 24153 | AFLAC | $2K | $167 | $2K | 2.18% |
| JOHN A HAWLEY3 Filed as: JOHN A. HAWLEY | 1390 SOUTHSIDE DRIVE SALEM, VA 24153 | AFLAC | $1K | $167 | $2K | 1.47% |
| MJ INSURANCE3 Filed as: MELVIN R. JONES AND VARIOUS AGENTS | 3025 ELIOCH MANOR DRIVE POWHATAN, VA 23139 | AFLAC | $942 | — | $942 | 0.91% |
| BRIAN CUMPTAN3 | 320 9TH STREET, SUITE 200 HUNTINGTON, WV 25701 | AFLAC | $457 | $156 | $613 | 0.59% |
| AUBREY W DAMRON3 Filed as: AUBREY W. DAMRON | 355 STONELEDGE DRIVE ROANOKE, VA 24019 | AFLAC | $390 | — | $390 | 0.38% |
| JACKSON D RHODES3 Filed as: JACKSON D. RHODES | 525 WEST OAKLAND AVENUE, SUITE 7 JOHNSON CITY, TN 37604 | AFLAC | $285 | — | $285 | 0.28% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 600 HIGHWAY 169 SOUTH, SUITE 1200 SAINT LOUIS PARK, MN 55426 | EYEMED VISION CARE | $3K | — | $3K | 9.84% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 613 RIVER PARK ROAD BELMONT, NC 28012 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $107 | — | $107 | 1.39% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | 2300 RENAISSANCE BOULEVARD KING OF PRUSSIA, PA 19406 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $107 | — | $107 | 1.39% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 601478 CHARLOTTE, NC 28260 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.12% |
| MACLELLAN, DANIEL, OWEN3 | PO BOX 58434 NASHVILLE, TN 37205 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.12% |
| TRIVETT WINGO4 Filed as: TRIVETT C. WINGO | PO BOX 303395 AUSTIN, TX 78703 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $1K | — | $1K | 18.52% |
| THE ROEBUCK GROUP LLC4 | 4240 PORTSMOUTH BOULEVARD CHESAPEAKE, VA 23321 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $93 | — | $93 | 1.27% |
| LOGAN T. DAVIS4 | 17 LINK ROAD LEXINGTON, VA 24450 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $64 | — | $64 | 0.87% |
| JUDITH S. BAKER4 | 3434 STONEHENGE SQUARE ROANOKE, VA 24018 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $38 | — | $38 | 0.52% |
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 | 457 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 469 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 572 | $2.8M |
| Dental | DELTA DENTAL OF VIRGINIA | 516 | $125K |
| Vision | EYEMED VISION CARE | 423 | $28K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 838 | $218K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 838 | $218K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 838 | $218K |
| Prescription drug | AETNA LIFE INSURANCE COMPANY | 572 | $2.8M |
| Other(5 contracts, 5 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 838 | $348K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 838 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.