| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 10050 REGENCY CIR STE 300 OMAHA, NE 681143722 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 8.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 400 MIDLAND DRIVE SUITE 300 MT LAUREL, NJ 08054 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $750 | $0 | $750 | 0.84% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 10050 REGENCY CIR STE 300 OMAHA, NE 681143722 | AMERITAS LIFE INSURANCE CORP | $2K | $0 | $2K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 2850 GOLF RD FL 21 ROLLING MEADOWS, IL 600084050 | AMERITAS LIFE INSURANCE CORP | $0 | $190 | $190 | 0.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC EIN 33-0441200 PHARMACY BENEFIT | Direct payment from the plan; Float revenue; Other fees; Claims processing Service code 12 | — | $636K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $86K |
| GALLAGHER BENEFITS SERVICES EIN 36-4291971 BROKER | Other commissions Service code 55 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | $25K |
| SILVERSTONE GROUP INCOPORATED EIN 47-0813106 BROKER | Other commissions Service code 55 | 11516 MIRACLE HILLS DR STE 100 OMAHA, NE 68154 | $16K |
| DELTA DENTAL OF NEBRASKA EIN 47-0685003 BENEFIT ADMISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $14K |
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 | 267 | 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) | 267 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | AMERITAS LIFE INSURANCE CORP | 374 | $23K |
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 267 | $89K |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 267 | $89K |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 267 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 374 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.