| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | ATTN FINANCE 2 PIERCE PL ITASCA, IL 34479 | STANDARD INSURANCE COMPANY | $34K | — | $34K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | ATTN FINANCE 2 PIERCE PL ITASCA, IL 60143 | STANDARD INSURANCE COMPANY | $6K | — | $6K | 2.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | TWO PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 1.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | ATTN FINANCE 2 PIERCE PL ITASCA, IL 60143 | STANDARD INSURANCE COMPANY | $23K | — | $23K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | ATTN FINANCE 2 PIERCE PL ITASCA, IL 60143 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 2.55% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | TWO PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 1.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | ATTN FINANCE 2 PIERCE PL ITASCA, IL 60143 | STANDARD INSURANCE COMPANY | $14K | — | $14K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | ATTN FINANCE 2 PIERCE PL ITASCA, IL 60143 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 2.59% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | TWO PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | STANDARD INSURANCE COMPANY | $970 | — | $970 | 1.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2 PIERCE PL 14TH FLOOR ITASCA, IL 60143 | VISION SERVICE PLAN | $2K | — | $2K | 2.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | — | EMPLOYERS DENTAL SERVICES | $1K | — | $1K | 4.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITEDHEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $506K |
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 | 1,307 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,307 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 1,593 | $699K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF ARIZONA | 724 | $633K |
| Vision | VISION SERVICE PLAN | 651 | $82K |
| Life insurance | STANDARD INSURANCE COMPANY | 1,096 | $152K |
| Short-term disability | STANDARD INSURANCE COMPANY | 1,093 | $230K |
| Long-term disability | STANDARD INSURANCE COMPANY | 330 | $92K |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 1,593 | $699K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,593 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.