| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | — | BLUECROSS BLUESHIELD OF ILLINOIS | $38K | $2K | $39K | 3.01% |
| THOREK MEMORIAL HOSPITAL3 | — | BLUECROSS BLUESHIELD OF ILLINOIS | — | $4 | $4 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BOULEVARD #14B CHICAGO, IL 60604 | BLUECROSS BLUESHIELD OF ILLINOIS | — | $1 | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BOULEVARD CHICAGO, IL 60604 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 7.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | — | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $5K | $5K | 5.45% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 181 EAST 5600 SOUTH SUITE 240 SALT LAKE CITY, UT 84107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | — | $12K | 14.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVENUE NORTHEAST SUITE 200 BELLEVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 2.88% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 181 EAST 5600 SOUTH SUITE 240 SALT LAKE CITY, UT 84107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 14.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVENUE NORTHEAST SUITE 200 BELLEVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 3.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 181 EAST 5600 SOUTH SUITE 240 SALT LAKE CITY, UT 84107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 14.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVENUE NORTHEAST SUITE 200 BELLEVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $398 | $398 | 2.98% |
| EOI SERVICE COMPANY INC3 | 1820 EAST 1ST STREET SUITE 400 SANTA ANNA, CA 92705 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $155 | — | $155 | 5.78% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 650 EAST CARMEL DRIVE SUITE 350 CARMEL, IN 46032 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $67 | $15 | $82 | 3.06% |
| EOI SERVICE COMPANY INC3 Filed as: EOI SERICE COMPANY INC | 1820 EAST 1ST STREET SUITE 400 SANTA ANNA, CA 92705 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $60 | — | $60 | 2.88% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 650 EAST CARMEL DRIVE SUITE 350 CARMEL, IN 46032 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $26 | $11 | $37 | 1.78% |
| EOI SERVICE COMPANY INC3 | 1820 EAST 1ST STREET SUITE 400 SANTA ANA, CA 92706 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 3.49% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 181 EAST 5600 SOUTH SUITE 240 SALT LAKE CITY, UT 84107 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 1.59% |
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 | 288 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 296 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 211 | $1.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 198 | $90K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 198 | $90K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 241 | $14K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 62 | $44K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 241 | $82K |
| Stop-loss / reinsurancereinsurance | BLUECROSS BLUESHIELD OF ILLINOIS | 211 | $1.3M |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 241 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 241 | — |
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."
No prospect flags tripped on this filing.