| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT | 4819 EMPEROR BLVD SUITE 200 DURHAM, NC 27703 | UNITED OF OMAHA LIFE INSURANCE CO | $4K | — | $4K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 220 EMERSON PL SUITE 200 DAVENPORT, IA 52801 | UNITED OF OMAHA LIFE INSURANCE CO | — | $708 | $708 | 1.58% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVE, NE SUITE 200 BELLVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE CO | — | $617 | $617 | 1.37% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT | 4819 EMPEROR BLVD SUITE 200 DURHAM, NC 27703 | UNITED OF OMAHA LIFE INSURANCE CO | $4K | — | $4K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 220 EMERSON PL SUITE 200 DAVENPORT, IA 52801 | UNITED OF OMAHA LIFE INSURANCE CO | — | $735 | $735 | 2.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVE SUITE 200 BELLVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE CO | — | $374 | $374 | 1.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT | 4819 EMPEROR BLVD SUITE 200 DURHAM, NC 27703 | UNITED OF OMAHA LIFE INSURANCE CO | $3K | — | $3K | 9.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 220 EMERSON PL SUITE 200 DAVENPORT, IA 52801 | UNITED OF OMAHA LIFE INSURANCE CO | — | $611 | $611 | 1.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVE, NE SUITE 200 BELLVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE CO | — | $395 | $395 | 1.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INTEGRA EMPL HEALTH DBA MAESTRO HEA EIN 56-1392505 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $33K |
| CIGNA EIN 59-1031071 PPO PROVIDER | Insurance services Service code 23 | — | $27K |
| TELADOC EIN 04-3705970 CONSULTING PROVIDER | Consulting (general) Service code 16 | — | $3K |
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 | 159 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE CO | 155 | $82K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE CO | 96 | $36K |
| Stop-loss / reinsurancereinsurance | GREAT MIDWEST INSURANCE COMPANY | 160 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 160 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.