| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 6325 RANCH DR LITTLE ROCK, AR 72223 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NATIONAL INCENTIVE 736 S STONE AVE LAGRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $223 | $223 | 0.83% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 6325 RANCH DR LITTLE ROCK, AR 72223 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NATIONAL INCENTIVE 736 S STONE AVE LAGRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $203 | $203 | 0.80% |
| GALLLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLLAGHER BENEFIT SERVICES INC | 6325 RANCH DR LITTLE ROCK, AR 72223 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| GALLLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLLAGHER BENEFIT SERVICES INC | NATIONAL INCENTIVE 736 S STONE AVE LAGRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $62 | $62 | 0.65% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 6325 RANCH DR LITTLE ROCK, AR 72223 | UNITED OF OMHA LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NATIONAL INCENTIVE 736 S STONE LAGRANGE, IL 60525 | UNITED OF OMHA LIFE INSURANCE COMPANY | — | $69 | $69 | 0.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR INC EIN 39-1995276 | Claims processing Service code 12 | — | $124K |
| GALLLAGHER BENEFIT SERVICES EIN 36-4291971 | Other commissions Service code 55 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | $23K |
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 | 102 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | ARKANSAS BLUE CROSS BLUE SHIELD | 169 | $54K |
| Vision | BLUE CROSS AND BLUE SHIELD - VISION | 125 | $11K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 99 | $35K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 91 | $320K |
| Other(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 99 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 169 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.