| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 2502 NORTH ROCKY POINT DRIVE SUITE 400 TAMPA, FL 33607 | BLUECROSS BLUESHIELD OF ILLINOIS | $46K | $945 | $47K | 3.89% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 2107 SOUTH NEIL STREET CHAMPAIGN, IL 61820 | BLUECROSS BLUESHIELD OF ILLINOIS | — | $5 | $5 | 0.00% |
| WELLS FARGO INSURANCE SERVICES3 | 2502 NORTH ROCKY POINT DRIVE SUITE 400 TAMPA, FL 33607 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $9K | — | $9K | 7.24% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 2502 NORTH ROCKY POIN DRIVE SUITE 400 TAMPA, FL 33607 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $433 | $4K | 18.24% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 2502 NORTH ROCKY POINT DRIVE SUITE 400 TAMPA, FL 33607 | HM LIFE INSURANCE COMPANY | $945 | — | $945 | 10.00% |
| HEALTH SPECIAL RISK, INC.3 | 880 SIBLEY MEMORIAL HIGHWAY SUITE 101 MENDOTA HEIGHTS, MN 55118 | AXIS INSURANCE COMPANY | $2K | — | $2K | 28.01% |
| JOHN LESLIE PECK3 | 2575 ULMERTON ROAD, SUITE 230 CLEARWATER, FL 33762 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $76 | — | $76 | 1.85% |
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 | 135 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 136 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 287 | $1.2M |
| Dental | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 269 | $125K |
| Vision | HM LIFE INSURANCE COMPANY | 117 | $9K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 128 | $26K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 128 | $22K |
| Prescription drug | BLUECROSS BLUESHIELD OF ILLINOIS | 287 | $1.2M |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 135 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 287 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.