| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | ANTHEM INSURANCE COMPANIES, INC. | $26K | $0 | $26K | 1.83% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 1900 WEST LOOP SOUTH, SUITE 1600 HOUSTON, TX 77027 | STANDARD INSURANCE COMPANY | $16K | $0 | $16K | 13.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | STANDARD INSURANCE COMPANY | $0 | $2K | $2K | 1.75% |
| CHAD L NELSON3 Filed as: CHAD M. THOMPSON | 3306 SPRING RIDGE PARKWAY OWENSBORO, KY 42303 | AFLAC | $3K | $458 | $4K | 5.56% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $4K | $0 | $4K | 5.35% |
| JENNIFER KELLER3 Filed as: JENNIFER NICOLE BURNS | 9471 STATE ROUTE 815 OWENSBORO, KY 42301 | AFLAC | $1K | $0 | $1K | 2.16% |
| JENNIFER KELLER3 Filed as: JENNIFER L. KELLER | 422 FREDERICA STREET OWENSBORO, KY 42301 | AFLAC | $775 | $106 | $881 | 1.33% |
| MJ INSURANCE3 Filed as: ROBBY D. SUTTON AND VARIOUS AGENTS | 11 DOCKSIDE LANE CADIZ, KY 42211 | AFLAC | $822 | $0 | $822 | 1.24% |
| JOSEPH GARETT KELLER3 | 422 FREDERICA STREET OWENSBORO, KY 42301 | AFLAC | $299 | $94 | $393 | 0.59% |
| KATHERINE J HARTZ3 Filed as: KATHERINE J. HARTZ | 7388 TELEPHONE ROAD NEWBURGH, IN 47630 | AFLAC | $87 | $0 | $87 | 0.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | PARAMOUNT DENTAL | $6K | $0 | $6K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | $1K | $0 | $1K | 9.08% |
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 | 188 | 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. |
| Total participants (= "Plan participants" tile) | 188 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 218 | $1.4M |
| Dental | PARAMOUNT DENTAL | 255 | $64K |
| Vision | VISION SERVICE PLAN | 127 | $14K |
| Life insurance | STANDARD INSURANCE COMPANY | 188 | $120K |
| Short-term disability | STANDARD INSURANCE COMPANY | 188 | $120K |
| Long-term disability | STANDARD INSURANCE COMPANY | 188 | $120K |
| Prescription drug | ANTHEM INSURANCE COMPANIES, INC. | 218 | $1.4M |
| Other(3 contracts, 3 carriers) | ANTHEM INSURANCE COMPANIES, INC. | 218 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 255 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.