| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES - GBS | 1900 W LOOP S SUITE 1600 HOUSTON, TX 77027 | SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. | $31K | — | $31K | 0.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE INC SOUTH | 1900 WEST LOOP SOUTH SUITE 1600 HOUSTON, TX 77027 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 0.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 3600 AMERICAN BOULEVARD WEST SUITE 500 BLOOMINGTON, MN 55431 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 0.11% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $38 | $38 | 0.00% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $6 | $6 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE INC SOUTH | 1900 WEST LOOP SOUTH SUITE 1600 HOUSTON, TX 77027 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 2.88% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 3600 AMERICAN BOULEVARD WEST SUITE 500 BLOOMINGTON, MN 55431 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 0.99% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $90 | $90 | 0.02% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $14 | $14 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1900 W LOOP S SUITE 1600 HOUSTON, TX 77027 | AETNA LIFE INSURANCE COMPANY | $1K | — | $1K | 0.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BSWIFT EIN 36-4391310 NONE | Contract Administrator Service code 13 | — | $186K |
| VISION SERVICE PLAN EIN 06-1227840 NONE | Contract Administrator Service code 13 | — | $150K |
| UNITED HEALTHCARE EIN 95-3939697 NONE | Contract Administrator Service code 13 | — | $109K |
| DELTA DENTAL EIN 94-2761537 NONE | Contract Administrator Service code 13 | — | $64K |
| MCCONNELL & JONES LLP EIN 76-0488832 NONE | Accounting (including auditing) Service code 10 | — | $55K |
| NORTHERN TRUST EIN 36-1561860 NONE | Trustee (directed) Service code 25 | — | $47K |
| CALLAN LLC EIN 94-2192581 NONE | Investment advisory (plan) Service code 27 | — | $35K |
| WELLS FARGO BANK EIN 94-2984229 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $32K |
| AETNA DENTAL EIN 06-6033492 NONE | Contract Administrator Service code 13 | — | $26K |
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 | 6,011 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 6,011 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. | 4,969 | $6.7M |
| Dental | AETNA LIFE INSURANCE COMPANY | 992 | $269K |
| Vision | VISION SERVICE PLAN | 4,652 | $774K |
| Life insurance(2 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 2,258 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,969 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.