| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| 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 | $4K | — | $4K | 9.97% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 3800 AMERICAN BLVD W SUITE 500 MINNEAPOLIS, MN 55431 | GUARDIAN | $4K | $2K | $6K | 23.14% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 16.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | — | $0 | — |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | — | $0 | — |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | — | $0 | — |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 | Non-monetary compensation; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Insurance brokerage commissions and fees; Other fees; Other commissions; Contract Administrator; Insurance agents and brokers; Float revenue Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | $357K |
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 | 364 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 364 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN | 371 | $26K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 607 | $37K |
| Life insurance(3 contracts, 2 carriers) | GUARDIAN | 371 | $26K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 0 | $0 |
| Long-term disability(2 contracts, 2 carriers) | GUARDIAN | 371 | $50K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE CO DBA ANTHEM BLUE CROSS & BLUE SHIELD | 653 | $322K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 0 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 653 | — |
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.