| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | DELTA DENTAL OF VIRGINIA | $28K | $0 | $28K | 4.18% |
| YOURPFO CONSULTING LLC3 Filed as: YOURPFO CONSULTING, LLC | 2500 WESTCHESTER AVE STE 401 PURCHASE, NY 10577 | DELTA DENTAL OF VIRGINIA | $5K | $0 | $5K | 0.79% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 21ST FLOOR TWO PIERCE PLACE ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | $0 | $13K | 5.65% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $2K | $2K | 1.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 21ST FLOOR TWO PIERCE PLACE ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $18K | $0 | $18K | 8.51% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $2K | $2K | 1.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 14TH FLOOR TWO PEARCE PLAZA ITASCA, IL 60143 | AETNA LIFE INSURANCE COMPANY | $12K | $0 | $12K | 8.82% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 21ST FLOOR TWO PIERCE PLACE ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 8.61% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $435 | $435 | 1.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $260 | $260 | 1.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 21ST FLOOR TWO PIERCE PLACE ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $0 | $0 | 0.00% |
| CHRISTIANSEN INSURANCE GROUP, INC.3 Filed as: CHRISTIANSEN INSURANCE INC | — | TRIPLE S SALUD, INC. | $858 | $0 | $858 | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL 14TH FL ITASCA, IL 60143 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $79 | $1K | 21.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 NONE | Contract Administrator Service code 13 | — | $648K |
| CAREBRIDGE CORPORATION EIN 23-2614764 NONE | Other fees; Contract Administrator; Other services Service code 13 | — | $24K |
| UNUM LIFE INSURANCE CO OF AMERICA EIN 01-0278678 NONE | Contract Administrator Service code 13 | — | $992 |
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 | 1,276 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 22 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 92 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,390 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 1,317 | $864K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF VIRGINIA | 2,160 | $682K |
| Vision | AETNA LIFE INSURANCE COMPANY | 2,004 | $131K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 700 | $250K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 446 | $232K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,520 | $258K |
| Prescription drug | TRIPLE S SALUD, INC. | 2 | $17K |
| Stop-loss / reinsurancereinsurance | AETNA LIFE INSURANCE COMPANY | 1,317 | $847K |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 700 | $233K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,520 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.