| 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 COMPANY | $63K | — | $63K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NATIONAL INCENTIVE 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $11K | $11K | 1.79% |
| 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 COMPANY | $14K | — | $14K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NATIONAL INCENTIVE 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $11K | $11K | 3.89% |
| 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 COMPANY | $9K | — | $9K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NATIONAL INCENTIVE 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 4.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 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 INC | NATIONAL INCENTIVE 736 S STONE AVE LA GRANGE, IL 60525 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $2K | $2K | 4.34% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 1166 AVENUE OF THE AMERICAS 22ND FLOOR NEW YORK, NY 10036 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH | $5K | — | $5K | 20.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J GALLAGHER & CO | 300 FELLOWSHIP ROAD SUITE 200 MOUNT LAUREL, NJ 08053 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $9 | — | $9 | 5.26% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EVERNORTH CARE SOLUTIONS, INC. EIN 86-1465626 ADMIN EMP ASSISTANCE PLAN | Participant communication; Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $46K |
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 | 519 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 501 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,020 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 10 | $171 |
| Vision | VISION SERVICE PLAN | 534 | $9K |
| Life insurance(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,020 | $986K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 483 | $87K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,020 | — |
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.