| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| 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 | $14K | — | $14K | 16.00% |
| HARNED, JEFF3 | 13117 EASTPOINT PARK BLVD SUIT LOUISVILLE, KY 40223 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 3.00% |
| 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 | $6K | — | $6K | 16.00% |
| HARNED, JEFF3 | 13117 EASTPOINT PARK BLVD SUIT LOUISVILLE, KY 40223 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $1K | $1K | 3.00% |
| 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 | — | — | $0 | 0.00% |
| 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 | $6K | — | $6K | 16.00% |
| HARNED, JEFF3 | 13117 EASTPOINT PARK BLVD SUIT LOUISVILLE, KY 40223 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $1K | $1K | 3.00% |
| 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 | $3K | — | $3K | 9.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 12750 MERIT DR SUITE 100 DALLAS, TX 75251 | GUARDIAN | $5K | $1K | $6K | 20.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 9.56% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 20.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 | Other commissions; Insurance agents and brokers; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Insurance brokerage commissions and fees; Contract Administrator; Other services; Non-monetary compensation Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | $565K |
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 | 413 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 413 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN | 351 | $28K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 581 | $37K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 621 | $117K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 122 | $37K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 351 | $64K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE CO DBA ANTHEM BLUE CROSS & BLUE SHIELD | 581 | $0 |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 621 | $158K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 621 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.