| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DAVID L. HERBRUCK3 Filed as: DAVID L HERBRUCK | 1100 SUPERIOR AVE E, STE 1700 CLEVELAND, OH 441142518 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 3.88% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 323 W LAKESIDE AVE STE 410 CLEVELAND, OH 44113 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 2.90% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 1.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 12750 MERIT DR SUITE 1000 DALLAS, TX 75251 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $6K | $10K | 8.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 323 W LAKESIDE AVE STE 410 CLEVELAND, OH 44113 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF ROAD 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $240 | $240 | 1.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ACRISURE LLC DBA BRITTON-GALLAGHER | 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 | Claims processing; Other fees; Contract Administrator; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $105K |
| GALLAGHER BENEFIT SERVICES INC. EIN 31-1440175 | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Non-monetary compensation; Other commissions; Insurance agents and brokers; Contract Administrator; Claims processing; Insurance brokerage commissions and fees Service code 12 | 2 PIERCE PLACE ITASCA, IL 60143 | $99K |
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 | 123 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 105 | $293K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 106 | $117K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 106 | $117K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 123 | $141K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 123 | $122K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 105 | $293K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 123 | $142K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 123 | — |
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.