| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 W. GOLF RD., FLOOR 4 ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF MICHIGAN | $38K | — | $38K | 2.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | TWO PIERCE PLAZA, 21ST FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $107K | — | $107K | 9.76% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 W. GOLF RD., 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $14K | $14K | 1.25% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES INC. | 30150 TELEGRAPH RD., SUITE 408 BINGHAM FARMS, MI 48025 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| BENEFIT COMMUNICATIONS INC3 Filed as: BENEFIT COMMUNICATIONS, INC. | 2977 SIDCO DR. NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $135K | $18K | $153K | 19.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 W. GOLF RD., 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $20K | $2K | $22K | 2.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | TWO PIERCE PLAZA, 21ST FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 1.44% |
| MORRIS, CHRISTOPHER, ROBERT3 | 2977 SIDCO DR. NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $796 | $28 | $824 | 0.10% |
| BENEFIT COMMUNICATIONS INC3 Filed as: BENEFIT COMMUNICATIONS, INC. | 2977 SIDCO DR. NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $117K | $7K | $124K | 40.47% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 W. GOLF RD., 11TH FLOOR ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $21K | $647 | $22K | 7.01% |
| MORRIS, CHRISTOPHER, ROBERT3 | 2977 SIDCO DR. NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $763 | $1 | $764 | 0.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 30150 TELEGRAPH RD., SUITE 408 BINGHAM FARMS, MI 48025 | EYE MED | $29K | — | $29K | 9.84% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 30150 TELEGRAPH RD., SUITE 408 BINGHAM FARMS, MI 48025 | HYATT LEGAL PLANS | $10K | — | $10K | 10.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES OF MI, I | 30150 TELEGRAPH RD., SUITE 408 BINGHAM FARMS, MI 48025 | HYATT LEGAL PLANS | — | $64 | $64 | 0.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Insurance services; Float revenue; Claims processing; Consulting (general); Contract Administrator; Other fees; Direct payment from the plan Service code 12 | — | $1.6M |
| UNUM LIFE ISNURANCE CO. OF AMERICA EIN 01-0278678 NONE | Contract Administrator Service code 13 | — | $84K |
| PLAN SOURCE EIN 20-1650604 NONE | Claims processing; Contract Administrator Service code 12 | — | $53K |
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 | 3,497 | 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) | 3,497 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MICHIGAN | 5,216 | $1.3M |
| Vision | EYE MED | 4,251 | $290K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,286 | $1.4M |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,286 | $1.1M |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,286 | $1.1M |
| Other(5 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,286 | $2.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,216 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.