| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE INC. | 245 S EXECUTIVE DRIVE SUITE 200 BROOKFIELD, WI 53005 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $35K | — | $35K | 0.84% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 245 S EXECUTIVE DR SUITE 200 BROOKFIELD, WI 53005 | DEAN HEALTH PLAN INC. | $17K | — | $17K | 1.62% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 245 S EXECUTIVE DRIVE SUITE 200 BROOKFIELD, WI 53005 | METROPOLITAN LIFE INSURANCE COMPANY | $61K | $10K | $71K | 9.23% |
| GROUP INSURANCE SERVICES INC3 | PO BOX 901 NAPERVILLE, IL 60566 | METROPOLITAN LIFE INSURANCE COMPANY | $38K | $8K | $46K | 6.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE INC. | 245 S EXECUTIVE DRIVE SUITE 200 BROOKFIELD, WI 53005 | KAISER FOUNDATION HEALTH PLAN INC. | $7K | — | $7K | 1.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 245 S EXECUTIVE DRIVE SUITE 200 BROOKFIELD, WI 53005 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 22.80% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES INC EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $656K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | — | $51K |
| GALLAGHER BENEFIT SERVICES INC EIN 36-4291971 BROKER | Insurance agents and brokers Service code 22 | 245 S EXECUTIVE DRIVE SUITE 200 BROOKFIELD, WI 53005 | $7K |
| GALLAGHER BENEFIT SERVICE INC EIN 36-4291971 BROKER | Other commissions Service code 55 | 245 S EXECUTIVE DRIVE SUITE 200 BROOKFIELD, WI 53005 | $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 | 1,205 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,221 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 808 | $5.8M |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 891 | $37K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,205 | $766K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,205 | $766K |
| Prescription drug(3 contracts, 3 carriers) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 808 | $5.8M |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 1,318 | $209K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 1,205 | $766K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,318 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.