| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLASHER BENEFIT SERVICES, INC.3 | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 63006 | DELTA DENTAL | $2K | — | $2K | 3.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD STE 1000 ROLLING MEADOWS, IL 60006 | STANDARD INSURANCE COMPANY | $8K | — | $8K | 23.92% |
| CONNECT SOURCE SOLUTIONS, INC.3 | 1150 HUNGRY NECK BLVD STE C121 MT PLEASANT, SC 29464 | STANDARD INSURANCE COMPANY | — | $661 | $661 | 1.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD STE 1000 ROLLING MEADOWS, IL 60008 | STANDARD INSURANCE COMPANY | $5K | — | $5K | 16.15% |
| CONNECT SOURCE SOLUTIONS, INC. | 1150 HUNGRY NECK BLVD STE C121 MT PLEASANT, SC 29464 | STANDARD INSURANCE COMPANY | — | $1K | $1K | 3.84% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD STE 1000 ROLLING MEADOWS, IL 60008 | STANDARD INSURANCE COMPANY | $5K | — | $5K | 16.48% |
| CONNECT SOURCE SOLUTIONS, INC. | 1155 HUNGRY NECK BLVD SUITE C121 MT PLEASANT, SC 29464 | STANDARD INSURANCE COMPANY | — | $1K | $1K | 3.90% |
| GALLAGHER BENEFIT SERVICES, INC.3 | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 63006 | DELTA DENTAL | $2K | — | $2K | 10.78% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 11219 FINANCIAL CENTRE PKWY, #311 FINANCIAL CENTRE PKWY, #311 LITTLE ROCK, AR 72211 | MEDICAL AIR SERVICES ASSOCIATION, INC. | $3K | — | $3K | 20.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD STE 1000 ROLLING MEADOWS, IL 60008 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 16.15% |
| CONNECT SOURCE SOLUTIONS, INC. | 1150 HUNGRY NECK BLVD STE C121 MT PLEASANT, SC 29464 | STANDARD INSURANCE COMPANY | — | $361 | $361 | 3.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE ADVANTAGE ADMINISTRATORS OF AR EIN 71-0226428 CONTACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $92K |
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 | 175 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL | 290 | $65K |
| Vision | DELTA DENTAL | 252 | $19K |
| Life insurance | STANDARD INSURANCE COMPANY | 232 | $29K |
| Short-term disability | STANDARD INSURANCE COMPANY | 45 | $32K |
| Long-term disability | STANDARD INSURANCE COMPANY | 19 | $9K |
| Other(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 40 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 290 | — |
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.