| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 555 S PERRYVILLE ROAD ROCKFORD, IL 61108 | HEALTH CARE SERVICES CORP | $46K | $2K | $48K | 4.16% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 555 S PERRYVILLE ROAD ROCKFORD, IL 65108 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 12.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | — | $1K | $1K | 5.20% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 555 S PERRYVILLE ROAD ROCKFORD, IL 61108 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $697 | — | $697 | 8.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF ROAD ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $109 | $109 | 1.25% |
| CREATIVE BENEFITS, INC.3 Filed as: CREATIVE BENEFIT SOLUTIONS, LLC | 3923 EAST STATE STREET ROCKFORD, IL 61108 | TRANSAMERICA LIFE INSURANCE COMPANY | $143 | — | $143 | 4.85% |
| CALVIN J KOHLENBERG3 | PO BOX 1513 DUBUQUE, IA 52004 | TRANSAMERICA LIFE INSURANCE COMPANY | $116 | — | $116 | 3.94% |
| JEFFREY W BLAKELY3 | 3515 DOUGLAS AVE DES MOINES, IA 50310 | TRANSAMERICA LIFE INSURANCE COMPANY | $24 | — | $24 | 0.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ENVISION HEALTHCARE INC. ADMINISTRATOR | Insurance services Service code 23 | 823 COMMERCE DRIVE, SUITE 325 OAK BROOK, IL 60523 | $16K |
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 | 193 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 193 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH CARE SERVICES CORP | 193 | $1.2M |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 119 | $27K |
| Short-term disability | TRANSAMERICA LIFE INSURANCE COMPANY | 5 | $3K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 27 | $9K |
| Other(2 contracts, 2 carriers) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 119 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 193 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.