| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD 11TH FLOOR ROLLING MEADOWS, IL 60008 | SYMETRA LIFE INSURANCE COMPANY | — | $4K | $4K | 3.58% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD 11TH FLOOR ROLLING MEADOWS, IL 60008 | BLUE CROSS BLUE SHIELD OF TEXAS | — | $2K | $2K | 3.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| RUSSELL INVESTMENTS TRUST COMPANY EIN 91-1116938 NONE | Investment management Service code 28 | — | $109K |
| BLUE CROSS BLUE SHIELD OF TEXAS EIN 36-1236610 NONE | Contract Administrator Service code 13 | — | $63K |
| EXPRESS SCRIPTS EIN 43-1420563 NONE | Contract Administrator Service code 13 | — | $37K |
| PRINCIPAL FINANCIAL GROUP, INC EIN 42-1520346 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $13K |
| STATE STREET GLOBAL ADVISORS TRUST EIN 81-4017137 NONE | Investment management Service code 28 | — | $7K |
| INCOME RESEARCH + MANAGEMENT EIN 04-2955404 NONE | Investment management Service code 28 | — | $455 |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 530 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 530 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 651 | $134K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF TEXAS | 101 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 651 | — |
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.