| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 116 HUNTINGTON AVE 10TH FLOOR BOSTON, MA 02116 | COMMUNITY INSURANCE COMPANY | — | — | $0 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1100 SUPERIOR AVE SUITE #1700 CLEVELAND, OH 44114 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $7K | $11K | 9.37% |
| CAPITAL PLANNERS LLC3 | 1191 LUDLAM CT MARCO ISLAND, FL 34145 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $36 | — | $36 | 0.03% |
| DAVID L. HERBRUCK3 | 1100 SUPERIOR AVE SUITE #1700 CLEVELAND, OH 441142518 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 5.75% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | TWO PIERCE PL, 14TH FL ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $1K | $4K | 5.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other fees; Claims processing; Contract Administrator; Other services Service code 12 | — | $137K |
| GALLAGHER BENEFIT SERVICES INC. | Insurance brokerage commissions and fees; Other commissions; Non-monetary compensation; Insurance agents and brokers Service code 22 | TWO PIERCE PLACE ITASCA, IL 60143 | $33K |
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 | 108 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 108 | $179K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 111 | $119K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 111 | $119K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 111 | $119K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 253 | $73K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 108 | $179K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 253 | $192K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 253 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.