| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 3600 AMERICAN BOULEVARD WEST SUITE 500 BLOOMINGTON, MN 55431 | BCBSMN, INC. DBA BLUE CROSS BLUE SHIELD OF MN | $0 | $18K | $18K | 1.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 3600 AMERICAN BOULEVARD WEST SUITE 500 BLOOMINGTON, MN 55431 | METROPOLITAN LIFE INSURANCE COMPANY | $918 | $9 | $927 | 1.49% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $61 | $61 | 0.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 100 MATSONFORD ROAD FOUR RADNOR CORP. CENTER, SUITE 510 RADNOR, PA 19087 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $1 | $1 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC. BROKER REP. | Other commissions Service code 55 | 3600 AMERICAN BOULEVARD WEST SUITE 500 BLOOMINGTON, MN 55431 | $91K |
| FORMULA CORPORATION EIN 41-1559435 ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $79K |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 4,077 | $62K |
| Stop-loss / reinsurancereinsurance | BCBSMN, INC. DBA BLUE CROSS BLUE SHIELD OF MN | 6,097 | $916K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 4,077 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,097 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.