| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES | 2 PIERCE PLACE 21ST FL ITASCA, IL 60143 | HARTFORD LIFE AND ACCIDENT | — | $8K | $8K | 3.55% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER VOLUNTARY BENEFITS LLC | PO BOX 71542 CHICAGO, IL 60695 | AMERICAN HERITAGE LIFE INSURANCE - ALLSTATE BENEFITS | — | $10K | $10K | 9.68% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFITS SERVICES | TWO PIERCE PLACE 17TH FL ITASCA, IL 60143 | AMERICAN HERITAGE LIFE INSURANCE - ALLSTATE BENEFITS | — | $8K | $8K | 8.04% |
| CHRISTOPHER J WILSON | 6575 PFEIL ROAD SCHERTZ, TX 78154 | AMERICAN HERITAGE LIFE INSURANCE - ALLSTATE BENEFITS | — | $8K | $8K | 7.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTH CARE SEVICES EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $286K |
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 | 433 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 446 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 872 | $1.1M |
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 872 | $1.1M |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 872 | $1.1M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 433 | $234K |
| Short-term disability | AMERICAN HERITAGE LIFE INSURANCE - ALLSTATE BENEFITS | 194 | $104K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 433 | $234K |
| Stop-loss / reinsurancereinsurance | UNITED HEALTHCARE INSURANCE COMPANY | 872 | $1.1M |
| Other | WORKERS ASSISTANCE PROGRAM, INC | 422 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 872 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.