| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE INC | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $36K | — | $36K | 0.77% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFITS SERVICES INC | 3600 AMERICAN BLVD. W S MINNEAPOLIS, MN 55431 | DEAN HEALTH PLAN INC | $19K | — | $19K | 1.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 245 S EXECUTIVE DR STE 200 BROOKFIELD, WI 53005 | KAISER FOUNDATION HEALTH PLAN INC | $8K | — | $8K | 1.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 245 S EXECUTIVE DR STE 200 BROOKFIELD, WI 53005 | METROPOLITAN LIFE INSURANCE COMPANY | $51K | $41 | $51K | 13.27% |
| GROUP INSURANCE SERVICES INC3 | PO BOX 901 NAPERVILLE, IL 60566 | METROPOLITAN LIFE INSURANCE COMPANY | $26K | $522 | $27K | 6.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | P O BOX 3009 ARLINGTON HEIGHTS, IL 60006 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $7K | $7K | 1.70% |
| GROUP INSURANCE SERVICES INC3 | PO BOX 901 NAPERVILLE, IL 60566 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $526 | $526 | 0.14% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1111 SUPERIOR AVE E STE 1601 CLEVELAND, OH 44114 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $84 | $84 | 0.02% |
| SCHWARZ INSURANCE AGENCY INC3 Filed as: SCHWARZ INSURANCE AGENCY IN | 1420 NORTH RIDGE DR PRAIRIE DU SAC, WI 53578 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $2 | $2 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 245 EXECUTIVE DR STE 200 BROOKFIELD, WI 53005 | SUN LIFE ASSURANCE COMPANY OF CANADA | $27K | — | $27K | 10.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PARK CENTRAL 12750 MERIT DR SUITE 1000 DALLAS, TX 75251 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | $2K | $10K | 27.26% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES INC EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $751K |
| GALLAGHER BENEFIT SERVICES INC EIN 36-4291971 BROKER | Other commissions Service code 55 | 245 S EXECUTIVE DR STE 200 BROOKFIELD, WI 53005 | $70K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | — | $57K |
| GALLAGHER BENEFIT SERVICES, INC EIN 36-4291971 BROKER | Insurance agents and brokers Service code 22 | 2850 GOLD RD. STE 1000 ROLLING MEADOWS, IL 60008 | $7K |
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 | 1,234 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,237 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 828 | $6.6M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 938 | $38K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,506 | $648K |
| Long-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,506 | $648K |
| Prescription drug(3 contracts, 3 carriers) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 828 | $6.6M |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 1,359 | $245K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 1,506 | $382K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,506 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.