| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | THE GALLAGHER PLACE 2 PIERCE PLACE ITASCA, IL 60143 | HIGHMARK BLUE CROSS BLUE SHIELD | $56K | — | $56K | 3.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PL 14TH FL ITASCA, IL 60143 | SUN LIFE ASSURANCE COMPANY OF CANADA | $10K | — | $10K | 5.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 3600 AMERICAN BLVD W STE 500 BLOOMINGTON, MN 55431 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $3K | $3K | 1.80% |
| TRIAD USA3 Filed as: TRIAD USA INC | 444 LIBERTY AVE PITTSBURGH, PA 15222 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 1.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. INC | 2 PIERCE PL 14TH FL ITASCA, IL 60143 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $4K | — | $4K | 3.01% |
| SOLENTURE INC3 | TWO GATEWAY CENTER 603 STANWIX ST, STE 1600 PITTSBURGH, PA 15222 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $8K | $0 | $8K | 8.45% |
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 | 205 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 210 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HIGHMARK BLUE CROSS BLUE SHIELD | 413 | $1.7M |
| Dental | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 459 | $143K |
| Vision | HIGHMARK BLUE CROSS BLUE SHIELD | 413 | $1.7M |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 210 | $191K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 210 | $191K |
| Prescription drug | HIGHMARK BLUE CROSS BLUE SHIELD | 413 | $1.7M |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 210 | $284K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 459 | — |
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.