| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 470 ATLANTIC AVENUE, FLOOR 13 BOSTON, MA 02210 | UNITED CONCORDIA INSURANCE COMPANY | $769 | — | $769 | 3.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 470 ATLANTIC AVENUE, FLOOR 13 BOSTON, MA 02210 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 8.75% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | STANDARD INSURANCE COMPANY | $396 | — | $396 | 2.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 470 ATLANTIC AVENUE, FLOOR 13 BOSTON, MA 02210 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 15.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | STANDARD INSURANCE COMPANY | $222 | — | $222 | 2.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | HIGHMARK INC. | $149 | — | $149 | 3.34% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MERITAIN HEALTH EIN 16-1264154 ADMINISTRATOR | Contract Administrator Service code 13 | — | $38K |
| CONCIERGE ADMINISTRATIVE SERVICES ADMINISTRATOR | Contract Administrator Service code 13 | 300 SE FRANK PHILLIPS BARTLESVILLE, OK 74003 | $19K |
| GALLAGHER BENEFITS BROKER | Insurance agents and brokers Service code 22 | 470 ATLANTIC AVENUE BOSTON, MA 02210 | $7K |
| FIRST STAFF BENEFITS BROKER | Insurance agents and brokers Service code 22 | 9847 BRYCE BOULEVARD PENDLETON, IN 46064 | $6K |
| KARI DUNN BROKER | Insurance agents and brokers Service code 22 | 12230 STONE HOUSE LANE FARRAGUT, TN 37934 | $5K |
| MIKE MARTENS BROKER | Insurance agents and brokers Service code 22 | 9847 BRYCE BOULEVARD PENDLETON, IN 46064 | $5K |
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 | 130 | 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) | 131 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 79 | $22K |
| Vision | HIGHMARK INC. | 56 | $4K |
| Life insurance | STANDARD INSURANCE COMPANY | 77 | $19K |
| Long-term disability | STANDARD INSURANCE COMPANY | 77 | $11K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 36 | $158K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 79 | — |
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.