| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC. | 295 WOODCLIFF DRIVE SUITE 101 FAIRPORT, NY 14450 | HEALTH NOW NEW YORK, INC. DBA BLUE CROSS BLUE SHIELD WESTERN NEW YORK | $13K | $0 | $13K | 3.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 1100 SUPERIOR AVENUE EAST SUITE 1700 CLEVELAND, OH 441142521 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $1K | $6K | 18.35% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES, INC. | 1100 SUPERIOR AVENUE EAST SUITE 1700 CLEVELAND, OH 44114 | EYEMED VISION CARE | $1K | $0 | $1K | 10.90% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 1100 SUPERIOR AVENUE EAST SUITE 1700 CLEVELAND, OH 441142521 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $668 | $219 | $887 | 13.27% |
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 | 293 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 293 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH NOW NEW YORK, INC. DBA BLUE CROSS BLUE SHIELD WESTERN NEW YORK | 174 | $612K |
| Dental | MEDICAL MUTUAL OF OHIO | 174 | $279K |
| Vision | EYEMED VISION CARE | 169 | $10K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 293 | $38K |
| Prescription drug(2 contracts, 2 carriers) | HEALTH NOW NEW YORK, INC. DBA BLUE CROSS BLUE SHIELD WESTERN NEW YORK | 174 | $612K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | HEALTH NOW NEW YORK, INC. DBA BLUE CROSS BLUE SHIELD WESTERN NEW YORK | 174 | $612K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 293 | — |
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.