| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 201 E. 4TH STREET CINCINNATI, OH 45202 | AETNA LIFE INSURANCE COMPANY | — | $4K | $4K | 0.48% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF RD. 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | -$29 | — | -$29 | -0.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 201 E. 4TH ST. STE 625 CINCINNATI, OH 45202 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $371 | $371 | 3.13% |
| CENTRO BENEFITS RESEARCH LLC3 | 325 N. KIRKWOOD RD. STE 300 KIRKWOOD, MO 63122 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $199 | $199 | 1.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 201 E. 4TH ST. CINCINNATI, OH 452024248 | AMERITAS LIFE INSURANCE CORPORATION | $404 | — | $404 | 10.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF RD. FL 21 ROLLING MEADOWS, IL 600084050 | AMERITAS LIFE INSURANCE CORPORATION | — | $71 | $71 | 1.76% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF RD. 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $122 | — | $122 | 10.87% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF RD. 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $743 | $743 | 69.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF RD. FL 21 ROLLING MEADOWS, IL 600084050 | AMERITAS LIFE INSURANCE CORP. | — | $71 | $71 | 13.30% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 201 E. 4TH ST. CINCINNATI, OH 452024248 | AMERITAS LIFE INSURANCE CORP. | $53 | — | $53 | 9.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF RD. FL 21 ROLLING MEADOWS, IL 600084050 | AMERITAS LIFE INSURANCE CORPORATION | $0 | $71 | $71 | 31.28% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 201 E. 4TH ST. CINCINNATI, OH 452024248 | AMERITAS LIFE INSURANCE CORPORATION | $23 | — | $23 | 10.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF RD. 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $331 | — | $331 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GALLAGHER BENEFIT SERVICES INC. NONE | Insurance agents and brokers Service code 22 | 201 E. 4TH STREET CINCINNATI, OH 45202 | $29K |
| CUSTOM DESIGN BENEFITS EIN 81-0798821 NONE | Plan Administrator Service code 14 | — | $4K |
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 | 90 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 93 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 110 | $728K |
| Dental | AETNA LIFE INSURANCE COMPANY | 110 | $728K |
| Vision(3 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORPORATION | 107 | $5K |
| Life insurance(4 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 81 | $36K |
| Short-term disability(3 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 81 | $36K |
| Long-term disability(4 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 81 | $46K |
| Other(3 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 81 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 110 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.