| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: JOHNSON & DUGAN INSURANCE SERVICES | 390 BRIDGE PARKWAY, SUITE 200 REDWOOD CITY, CA 94065 | ANTHEM INSURANCE COMPANIES, INC. | $23K | $0 | $23K | 1.64% |
| ASSUREDPARTNERS3 Filed as: JOHNSON & DUGAN INSURANCE SERVICES | 390 BRIDGE PARKWAY, SUITE 200 REDWOOD CITY, CA 94065 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 6.84% |
| ASSUREDPARTNERS3 Filed as: JOHNSON & DUGAN INSURANCE SERVICES | 390 BRIDGE PARKWAY, SUITE 200 REDWOOD CITY, CA 94065 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 15.53% |
| ASSUREDPARTNERS3 Filed as: JOHNSON & DUGAN INSURANCE SERVICES | 390 BRIDGE PARKWAY, SUITE 200 REDWOOD CITY, CA 94065 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.14% |
| SYNJYN DAYS3 | 1050 CROWN POINTE PARKWAY, STE 1800 ATLANTA, GA 30338 | UNUM INSURANCE COMPANY | $1K | $0 | $1K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE GUARDIAN LIFE INSURANCE COMPANY EIN 13-5123390 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $11K |
| JOHNSON & DUGAN INSURANCE SERVICES EIN 94-2917627 INSURANCE BROKER | Insurance agents and brokers Service code 22 | — | $5K |
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 | 125 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 107 | $1.4M |
| Vision | VISION SERVICE PLAN | 123 | $24K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 123 | $38K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 125 | $104K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 125 | $104K |
| Prescription drug | ANTHEM INSURANCE COMPANIES, INC. | 107 | $1.4M |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 123 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 125 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.