| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.5 Filed as: GALLAGHER BENEFIT SOLUTIONS | 6300 S OLD VILLAGE PL STE 200 SIOUX FALLS, SD 47101 | DELTA DENTAL OF SOUTH DAKOTA | $1K | — | $1K | 2.29% |
| GALLAGHER BENEFIT SERVICES, INC.5 Filed as: GALLAGHER BENEFIT SERVICES | 6300 S OLD VILLAGE PL STE 200 SIOUX FALLS, SD 571082103 | VISION SERVICE PLAN | $1K | — | $1K | 4.80% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CWI BENEFITS EIN 57-0870204 MEDICAL CLAIMS PROCESSING | Claims processing Service code 12 | PO BOX 6125 GREENVILLE, SC 29606 | $30K |
| CIGNA EIN 59-1031071 PPO PROVIDER | Other fees Service code 99 | 900 COTTAGE GROVE RD. BLOOMFIELD, CT 60022 | $6K |
| FIRST HEALTH GROUP CORP PPO PROVIDER | Other fees Service code 99 | 3200 HIGHLAND AVE DOWNERS GROVE, IL 60515 | $2K |
| MULTI PLAN EIN 13-3068979 PPO PROVIDER | Other fees Service code 99 | 535 E. DIEHL ROAD NAPERVILLE, IL 60563 | -$368 |
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 | 83 | 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) | 83 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF SOUTH DAKOTA | 137 | $55K |
| Vision | VISION SERVICE PLAN | 62 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 137 | — |
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."
No prospect flags tripped on this filing.