| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | $0 | $14K | 11.37% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 736 SOUTH STONE AVENUE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $9K | $9K | 7.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 615 EAST BRITTON ROAD OKLAHOMA CITY, OK 73114 | BLUECROSS BLUESHIELD OF TEXAS | $5K | $5K | $10K | 20.35% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | BLUECROSS BLUESHIELD OF TEXAS | $0 | $10 | $10 | 0.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60690 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $751 | $751 | 1.78% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2000 MORRIS AVENUE, APARTMENT 1400 BIRMINGHAM, AL 35203 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $212 | $212 | 0.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2000 MORRIS AVENUE APARTMENT 1400 BIRMINGHAM, AL 35203 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $106 | $106 | 0.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | DEARBORN LIFE INSURANCE COMPANY | $1K | $0 | $1K | 9.43% |
| W. WILLIAM WORNARDT III4 Filed as: W. WILLIAM WORNARDT, III | 7707 TIBURON TRIAL SUGAR LAND, TX 77479 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $117 | — | $117 | 4.05% |
| MARIAN K. SMITH4 | 686 JESTER RIDGE NEW BRAUNFELS, TX 78130 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $98 | — | $98 | 3.39% |
No Schedule C service providers reported on this filing.
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 | 128 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUECROSS BLUESHIELD OF TEXAS | 180 | $48K |
| Vision | DEARBORN LIFE INSURANCE COMPANY | 104 | $12K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 128 | $120K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 128 | $120K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 128 | $120K |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 128 | $165K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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.