| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NEW JERSEY PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED OF OMAHA LIFE INSURANCE | $48K | — | $48K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE | — | $16K | $16K | 3.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | NATIONAL INCENTIVE 2850 GOLF RD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE | — | $16K | $16K | 5.21% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NEW JERSEY PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED OF OMAHA LIFE INSURANCE | $16K | — | $16K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NEW JERSEY PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED OF OMAHA LIFE INSURANCE | $8K | — | $8K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | NATIONAL INCENTIVE 2850 GOLF RD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE | — | $6K | $6K | 7.21% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES INC | NEW JERSEY PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | MUTUAL OF OMAHA INSURANCE COMPANY | $6K | — | $6K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | NATIONAL INCENTIVE 2850 GOLF RD ROLLING MEADOWS, IL 60008 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $3K | $3K | 8.23% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NEW JERSEY PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $3K | $0 | $3K | 10.00% |
| DAN (OLIVIA) WU3 | MERCER 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | ACE AMERICAN INSURANCE COMPANY | $3K | $0 | $3K | 20.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO | 4000 MIDLANTIC DRIVE SUITE 300 MOUNT LAUREL, NJ 08054 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $8 | $0 | $8 | 4.91% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 ADMIN EMP ASSISTANCE PLAN | Direct payment from the plan; Contract Administrator; Participant communication; Claims processing Service code 12 | PO BOX 1450 NW 7307 MINNEAPOLIS, MN 55486 | $41K |
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 | 520 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 446 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 966 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 10 | $163 |
| Life insurance(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE | 966 | $848K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE | 487 | $83K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 966 | — |
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.