| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 100 MERIDIAN CENTRE BLVD SUITE 100 ROCHESTER, NY 14618 | EXCELLUS BLUE CROSS BLUE SHIELD | $28K | — | $28K | 4.39% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 4.70% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | NEW YORK PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | COMPANION LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | NATIONAL INCENTIVE 2850 GOLF RD ROLLING MEADOWS, IL 60008 | COMPANION LIFE INSURANCE COMPANY | — | $1K | $1K | 3.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 100 MERIDIAN CENTRE BLVD SUITE 100 ROCHESTER, NY 14618 | LINCOLN LIFE AND ANNUITY COMPANY OF NEW YORK | $2K | — | $2K | 9.05% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | — | LINCOLN LIFE AND ANNUITY COMPANY OF NEW YORK | — | $63 | $63 | 0.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | NEW YORK PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | MUTUAL OF OMAHA INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | NATIONAL INCENTIVE 2850 GOLF RD ROLLING MEADOWS, IL 60008 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $413 | $413 | 3.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 | — | VISION SERVICE PLAN | $703 | — | $703 | 7.83% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | NEW YORK PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | COMPANION LIFE INSURANCE COMPANY | $852 | — | $852 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | NATIONAL INCENTIVE 2850 GOLF RD ROLLING MEADOWS, IL 60008 | COMPANION LIFE INSURANCE COMPANY | — | $268 | $268 | 3.15% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | NEW YORK PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | MUTUAL OF OMAHA INSURANCE COMPANY | $155 | — | $155 | 10.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | NATIONAL INCENTIVE 2850 GOLF RD ROLLING MEADOWS, IL 60008 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $49 | $49 | 3.17% |
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 | 123 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 81 | $642K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 90 | $78K |
| Vision | VISION SERVICE PLAN | 72 | $9K |
| Life insurance(2 contracts) | COMPANION LIFE INSURANCE COMPANY | 123 | $42K |
| Short-term disability | LINCOLN LIFE AND ANNUITY COMPANY OF NEW YORK | 123 | $24K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 65 | $13K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 81 | $642K |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 123 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 123 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.