| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | TWO PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | BLUECROSS BLUESHIELD OF ILLINOIS | $356 | $168 | $524 | 0.18% |
| THE ULTIMATE SOFTWARE GROUP3 Filed as: THE ULTIMATE SOFTWARE GROUP INC. | 1485 NORTH PARK DRIVE WESTON, FL 33326 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $1K | $1K | 3.71% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 072103 CARMEL 2 PO BOX 4135 CLINTON, IA 52733 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $524 | $138 | $662 | 1.84% |
| THE ULTIMATE SOFTWARE GROUP3 Filed as: THE ULTIMATE SOFTWARE GROUP INC. | 1485 NORTH PARK DRIVE WESTON, FL 33326 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $1K | $1K | 3.71% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 072103 CARMEL 2 PO BOX 4135 CLINTON, IA 52733 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $462 | $130 | $592 | 1.86% |
| THE ULTIMATE SOFTWARE GROUP3 Filed as: THE ULTIMATE SOFTWARE GROUP INC. | 1485 NORTH PARK DRIVE WESTON, FL 33326 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $332 | $332 | 3.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 072103 CARMEL 2 PO BOX 4135 CLINTON, IA 52733 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $221 | $86 | $307 | 3.27% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 072103 CARMEL 2 PO BOX 4135 CLINTON, IA 52733 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $10 | $10 | $20 | 3.62% |
| THE ULTIMATE SOFTWARE GROUP3 Filed as: THE ULTIMATE SOFTWARE GROUP INC. | 1485 NORTH PARK DRIVE WESTON, FL 33326 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $20 | $20 | 3.62% |
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 | 52 | 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) | 52 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 52 | $288K |
| Vision | VISION SERVICE PLAN | 52 | $6K |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 52 | $10K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 52 | $36K |
| Other(3 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 52 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 52 | — |
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.