| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | MEDICAL MUTUAL | $43K | $30K | $73K | 3.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF OHIO | $4K | $82 | $5K | 4.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 1111 SUPERIOR AVENUE E SUITE 1601 CLEVELAND, OH 44114 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 9.20% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 5.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1111 SUPERIOR AVENUE E SUITE 1601 CLEVELAND, OH 44114 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $0 | $5K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 5.51% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1111 SUPERIOR AVENUE E SUITE 1601 CLEVELAND, OH 44114 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $987 | $987 | 5.15% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | — | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | $0 | $2K | 11.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1111 SUPERIOR AVENUE E SUITE 1601 CLEVELAND, OH 44114 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $837 | $837 | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1111 SUPERIOR AVENUE E SUITE 1601 CLEVELAND, OH 44114 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 14.65% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $0 | $91 | $91 | 1.29% |
| THOMAS W BOSTON3 | 1275 WEST MAPLE STREET HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3 | $0 | $3 | 0.04% |
| CRAIG T LESLIE3 | 38110 THIRD STREET WILLOUGHBY, OH 44094 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3 | $0 | $3 | 0.04% |
| ERIKA M PERRIN3 | 11565 GRENADA CIRCLE NORTHEAST HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3 | $0 | $3 | 0.04% |
| LINDA LEE BOSTON3 | 1275 WEST MAPLE STREET HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1111 SUPERIOR AVENUE EAST SUITE 1601 CLEVELAND, OH 44114 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $621 | $0 | $621 | 13.22% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $0 | $94 | $94 | 2.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | — | FIDELITY SECURITY LIFE INSURANCE COMPANY | $28 | $0 | $28 | 12.96% |
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 | 181 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 184 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MEDICAL MUTUAL | 181 | $2.0M |
| Dental | DELTA DENTAL OF OHIO | 290 | $95K |
| Vision(2 contracts) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 252 | $17K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 283 | $36K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 53 | $34K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 283 | $48K |
| Prescription drug | MEDICAL MUTUAL | 181 | $2.0M |
| Other(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 283 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 290 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.