| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLYDE A STOCKEY3 | 1518 MIKE CT SHAKOPEE, MN 55379 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $52K | — | $52K | 4.94% |
| NATIONAL BENEFIT CENTER3 Filed as: NATIONAL BENEFIT CENTER LLC | 1105 NORTH MARKET ST SUITE 1300 WILMINGTON, DE 19801 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $420 | — | $420 | 0.04% |
| CLYDE A STOCKEY3 | 1518 MIKE CT SHAKOPEE, MN 55379 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 1.92% |
| NATIONAL BENEFIT CENTER3 Filed as: NATIONAL BENEFIT CENTER LLC | 1105 NORTH MARKET ST SUITE 1300 WILMINGTON, DE 19801 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $128 | — | $128 | 0.05% |
| CALVO'S INSURANCE UNDERWRITERS, INC3 Filed as: CALVO'S INSURANCE UNDERWRITER'S INC | PO BOX FJ HAGATNA, GU 96932 | TOKIO MARINE PACIFIC INSURANCE LTD | $3K | — | $3K | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHNOW NY DBA BCBS OF WNY EIN 16-1105741 INSURANCE CO | Insurance services; Claims processing Service code 12 | — | $0 |
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 | 2,072 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 20 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 64 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TOKIO MARINE PACIFIC INSURANCE LTD | 22 | $161K |
| Dental(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,711 | $444K |
| Vision(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,711 | $444K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,834 | $1.1M |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,834 | $1.1M |
| Prescription drug | TOKIO MARINE PACIFIC INSURANCE LTD | 22 | $161K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,834 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,834 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.