| 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 | $45K | — | $45K | 3.21% |
| 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 | $117K | — | $117K | 9.77% |
| 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 | — | $15K | $15K | 1.25% |
| BENEFIT COMMUNICATIONS INC3 Filed as: BENEFIT COMMUNICATIONS, INC. | 2977 SIDCO DR. NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $153K | $20K | $174K | 20.30% |
| 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 | $24K | $2K | $26K | 3.00% |
| 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 | $10K | — | $10K | 1.20% |
| MORRIS, CHRISTOPHER, ROBERT3 | 2977 SIDCO DR. NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $371 | — | $371 | 0.04% |
| BENEFIT COMMUNICATIONS INC3 Filed as: BENEFIT COMMUNICATIONS, INC. | 2977 SIDCO DR. NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $85K | $9K | $95K | 28.28% |
| 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 | $15K | $926 | $16K | 4.77% |
| MORRIS, CHRISTOPHER, ROBERT3 | 2977 SIDCO DR. NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $83 | — | $83 | 0.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 30150 TELEGRAPH RD., SUITE 408 BINGHAM FARMS, MI 48025 | EYE MED | $28K | — | $28K | 8.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES,INC. | 30150 TELEGRAPH RD., SUITE 408 BINGHAM FARMS, MI 48025 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE CO. | $10K | $139 | $11K | 9.40% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES,INC. | P.O. BOX 3009 ARLINGTON HTS., IL 60006 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE CO. | — | $1K | $1K | 1.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 35 WATERVIEW BLVD. SUITE 300 PARSIPPANY, NJ 07054 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE CO. | — | $237 | $237 | 0.21% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | TWO PIERCE PLAZA, 21ST FLOOR ITASCA, IL 60143 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE CO. | — | $125 | $125 | 0.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES,INC. | 2850 W. GOLF RD., 11TH FLOOR ROLLING MEADOWS, IL 60008 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE CO. | — | $112 | $112 | 0.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Claims processing; Float revenue; Insurance services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Direct payment from the plan; Consulting (general) Service code 12 | — | $1.4M |
| GALLAGHER BENEFIT SERVICES EIN 36-4291971 BROKER | Other fees; Insurance agents and brokers; Other commissions; Non-monetary compensation; Insurance brokerage commissions and fees Service code 22 | 30150 TELEGRAPH RD. SUITE 408 BINGHAM FARMS, MI 48025 | $136K |
| UNUM LIFE ISNURANCE CO. OF AMERICA EIN 01-0278678 NONE | Contract Administrator Service code 13 | — | $97K |
| PLAN SOURCE EIN 20-1650604 NONE | Claims processing; Contract Administrator Service code 12 | — | $64K |
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 | 3,404 | 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) | 3,404 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MICHIGAN | 5,337 | $1.4M |
| Vision | EYE MED | 4,331 | $330K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,388 | $1.5M |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,388 | $1.2M |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,388 | $1.2M |
| Other(5 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,388 | $2.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,337 | — |
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.