| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUGLAS L DERKS3 Filed as: DOUGLAS DERKS | 2 PIERCE PL 14TH FL ITASCA, IL 60143 | PRIORITY HEALTH | $15K | $0 | $15K | 2.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 30150 TELEGRAPH RD STE 408 BINGHAM FARMS, MI 480255708 | UNITEDHEALTHCARE INSURANCE COMPANY | $38K | $0 | $38K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | TWO PIERCE PL FL 14 ITASCA, IL 60143 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | $1K | $1K | 0.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 300 OTTAWA AVE NW STE 301 GRAND RAPIDS, MI 49503 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $741 | $0 | $741 | 12.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| VARIPRO TPA | Claims processing Service code 12 | 5300 PATTERSON AVE SE STE 150 GRAND RAPIDS, MI 49512 | $7K |
| GALLAGHER BENEFIT SERVICES INC AGENT | Insurance agents and brokers; Insurance brokerage commissions and fees; Non-monetary compensation; Other commissions Service code 22 | 2850 GOLF RD STE 1000 ROLLING MEADOWS, IL 60008 | $0 |
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 | 135 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 1 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 138 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PRIORITY HEALTH | 212 | $1.5M |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 151 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 212 | — |
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.