| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 201 E. 4TH ST. CINCINNATI, OH 45202 | AETNA LIFE INSURANCE CO. | $4K | — | $4K | 0.63% |
| BRIAN WHITE3 Filed as: BRIAN KEMPTON | 2850 GOLD ROAD ROLLING MEADOWS, IL 60008 | BLUE CARE NETWORK OF MICHIGAN | $19K | — | $19K | 4.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 21ST FLOOR TWO PIERCE PL. ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 15.00% |
| 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 | — | $364 | $364 | 1.25% |
| BRIAN WHITE3 Filed as: BRIAN KEMPTON | 2850 GOLD ROAD ROLLING MEADOWS, IL 60008 | BLUE CROSS BLUE SHIELD | $1K | — | $1K | 4.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | P.O BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 12.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 W. GOLD RD. 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $296 | $296 | 1.25% |
| 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 | $3K | $276 | $3K | 13.84% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC. | 21ST FL TWO PIERCE PL ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $531 | — | $531 | 2.41% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 W. GOLF RD. 11TH FLOOR ROLLING MEADOWS, IL 60008 | STARMOUNT LIFE INSURANCE COMPANY | $1K | $139 | $1K | 11.43% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 21ST FL TWO PIERCE PL ITASCA, IL 60143 | STARMOUNT LIFE INSURANCE COMPANY | $201 | — | $201 | 1.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 21ST FLOOR TWO PIERCE PL. ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $781 | — | $781 | 7.30% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 W. GOLF ROAD 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $611 | $94 | $705 | 9.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 21ST FL TWO PIERCE PL ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $145 | — | $145 | 1.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GALLAGHER BENEFIT SERVICES INC. EIN 36-4291971 NONE | Insurance agents and brokers Service code 22 | — | $13K |
| CUSTOM DESIGN BENEFITS EIN 81-0798821 NONE | Plan Administrator Service code 14 | — | $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 | 150 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 155 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA LIFE INSURANCE CO. | 226 | $1.1M |
| Dental | AETNA LIFE INSURANCE CO. | 226 | $694K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 99 | $11K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 176 | $30K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 77 | $40K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 77 | $53K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CARE NETWORK OF MICHIGAN | 80 | $430K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 176 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 226 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.