| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $1K | $1K | 0.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $23K | — | $23K | 10.00% |
| SUSAN WRIGHT3 | 4923 LAKERIDGE DRIVE EAST LAKE TAPPS, WA 98391 | AFLAC | $1K | $125 | $1K | 6.99% |
| MJ INSURANCE3 Filed as: ANDREA PHANEUF AND VARIOUS AGENTS | 14127 SE 281ST PLACE KENT, WA 98042 | AFLAC | $816 | $2 | $818 | 4.54% |
| KIMBERLY FERGUSON3 Filed as: KIMBERLY MOGER | 14716 SE 83RD PLACE NEWCASTLE, WA 98059 | AFLAC | $496 | $11 | $507 | 2.81% |
| ANNA JANICE RUIZ3 Filed as: ANNA HOOBLER | 14220 INTERURBAN AVENUE SOUTH SUITE 150 TUKWILA, WA 98168 | AFLAC | $276 | $25 | $301 | 1.67% |
| BRANDON PENKO3 Filed as: BRANDON HOOBLER | 14220 INTERURBAN AVENUE SOUTH SUITE 150 TUKWILA, WA 98168 | AFLAC | $186 | $27 | $213 | 1.18% |
| JOHN G CURTIS3 Filed as: JOHN CURTIS | 1103 SCHROCK ROAD, SUITE 201 COLUMBUS, OH 43229 | AFLAC | $181 | — | $181 | 1.00% |
| THERESA ANTHONY3 | 3778 RIVERSIDE DRIVE MASON, OH 45040 | AFLAC | $171 | — | $171 | 0.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $916 | — | $916 | 10.00% |
| GEORGE BLAIR WEILER3 Filed as: GEORGE WEILER | 14 WALL STREET, SUITE 8C NEW YORK, NY 10005 | AFLAC | $88 | $10 | $98 | 3.95% |
| SHARON NEIMANIS3 | 45 OLD OX ROAD MANHASSET, NY 11030 | AFLAC | $60 | — | $60 | 2.42% |
| KIMBERLY FERGUSON3 Filed as: KIMBERLY MOGER | 601 108TH AVENUE NE, SUITE 1900 BELLEVUE, WA 98004 | AFLAC | $42 | — | $42 | 1.69% |
| MJ INSURANCE3 Filed as: TODD BURKE CORP AND VARIOUS AGENTS | 2 IRIS LANE GARDEN CITY, NY 11530 | AFLAC | $29 | $4 | $33 | 1.33% |
| SHAUN T KONIOR3 Filed as: SHAUN KONIOR | 255 SOUTH 13TH, SUITE 1 LINDENHURST, NY 11757 | AFLAC | $32 | — | $32 | 1.29% |
| KENETH C. MEIER CORPORATION3 | 401 FRANKLIN AVENUE, SUITE 312 GARDEN CITY, NY 11530 | AFLAC | $15 | $2 | $17 | 0.68% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: RUHLE RISK MANAGEMENT | 200 GARDEN CITY PLAZA, SUITE 410 GARDEN CITY, NY 11530 | AFLAC | $16 | — | $16 | 0.64% |
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 | 566 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 578 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 25 | $302K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 20 | $232K |
| Vision(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 329 | $272K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 558 | $400K |
| Short-term disability(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 558 | $411K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 558 | $400K |
| Prescription drug | GROUP HEALTH COOPERATIVE | 7 | $50K |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 558 | $631K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 558 | — |
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.