| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1111 SUPERIOR AVE SUITE 1601 CLEVELAND, OH 44114 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $7K | $11K | 9.83% |
| DAVID L. HERBRUCK3 | 1100 SUPERIOR AVE SUITE 1700 CLEVELAND, OH 441142518 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PL, 14TH FL ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $1K | $4K | 4.83% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: BRITTON-GALLAGHER AND ASSOCIATES IN | 1375 EAST 9TH ST. FL 30 CLEVELAND, OH 44114 | FEDERAL INSURANCE COMPANY | $113 | — | $113 | 15.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 | Other services; Contract Administrator; Claims processing; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $119K |
| GALLAGHER BENEFIT SERVICES INC. | Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers Service code 22 | 2 PIERCE PLACE ITASCA, IL 60143 | $31K |
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 | 106 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 108 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 106 | $212K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 106 | $116K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 106 | $116K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 243 | $87K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 243 | $87K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 106 | $212K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 243 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 243 | — |
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."
No prospect flags tripped on this filing.