| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1111 SUPERIOR AVE E SUITE 1601 CLEVELAND, OH 44114 | INDEPENDENT HEALTH | $8K | $0 | $8K | 4.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 295 WOODCLIFF DRIVE SUITE 101 FAIRPORT, NY 14450 | BLUE CROSS BLUE SHIELD WESTERN NEW YORK | $2K | $0 | $2K | 3.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1111 SUPERIOR AVE E SUITE 1601 CLEVELAND, OH 44114 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $847 | $6K | 17.56% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $678 | $678 | 2.05% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1111 SUPERIOR AVE E SUITE 1601 CLEVELAND, OH 44114 | EYEMED VISION CARE | $947 | $0 | $947 | 10.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1111 SUPERIOR AVE SUITE 1601 CLEVELAND, OH 44114 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $531 | $162 | $693 | 13.05% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $130 | $130 | 2.45% |
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 | 218 | 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) | 218 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | MEDICAL MUTUAL OF OHIO | 138 | $480K |
| Dental | MEDICAL MUTUAL OF OHIO | 138 | $221K |
| Vision | EYEMED VISION CARE | 136 | $9K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 218 | $38K |
| Prescription drug(3 contracts, 3 carriers) | MEDICAL MUTUAL OF OHIO | 138 | $480K |
| Stop-loss / reinsurancereinsurance(3 contracts, 3 carriers) | MEDICAL MUTUAL OF OHIO | 138 | $480K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 218 | — |
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.