| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1100 SUPERIOR AVE, SUITE #1700 CLEVELAND, OH 44114 | GUARDIAN | $9K | $4K | $12K | 21.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1111 SUPERIOR AVENUE E, SUITE #1601 CLEVELAND, OH 44114 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $3K | $0 | $3K | 9.89% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS YOUNGSTOWN | 21ST FL 2 PIERCE PL ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 14.64% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $217 | $0 | $217 | 1.22% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 21ST FL 2 PIERCE PL ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE | $195 | $0 | $195 | 2.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 21ST FL 2 PIERCE PL ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $114 | $0 | $114 | 4.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 | Other services; Other fees; Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $266K |
| GALLAGHER BENEFIT SERVICES INC EIN 31-1440175 | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees; Non-monetary compensation Service code 22 | TWO PIERCE PLACE ITASCA, IL 60143 | $0 |
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 | 331 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 332 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN | 361 | $58K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 594 | $33K |
| Life insurance | GUARDIAN | 361 | $58K |
| Short-term disability(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 40 | $30K |
| Long-term disability(4 contracts, 3 carriers) | GUARDIAN | 361 | $89K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE CO DBA ANTHEM BLUE CROSS & BLUE SHIELD | 677 | $356K |
| Other | GUARDIAN | 361 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 677 | — |
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.