| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES INC | 13965 W CHINDEN BLVD STE 300 BOISE, ID 83713 | AMERITAS LIFE INSURANCE CORP | $60K | — | $60K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 50 BRAINTREE HILL OFFICE PARK STE 310 BRAINTREE, MA 02184 | AMERITAS LIFE INSURANCE CORP | — | $4K | $4K | 0.58% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES INC. | 13965 W CHINDEN BLVD STE 300 BOISE, ID 83713 | RELIANCE STANDARD LIFE INSURANCE CO | $67K | — | $67K | 17.53% |
| TOTAL BENEFIT SOLUTIONS3 Filed as: TOTAL BENEFIT SOLUTION | 8008 SLIDE ROAD SUITE 14 LUBBOCK, TX 79424 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $14K | — | $14K | 20.02% |
| BILL HARTSFIELD & ASSOCIATES3 | 4902 LAKERIDGE DR LUBBOCK, TX 79424 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 1.62% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES, INC | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $539 | — | $539 | 0.77% |
| DAVIS ALLEN AGENCY INC3 | 7412 UNIVERSITY AVE UNIT 1 LUBBOCK, TX 79423 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $249 | — | $249 | 0.35% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH CARE SERVICE CORPORATION EIN 36-1236610 SERVICE PROVIDER | Contract Administrator Service code 13 | 300 EAST RANDOLPH STREET CHICAGO, IL 60601 | $0 |
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 | 2,935 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH CARE SERVICE CORPORATION | 0 | $1.5M |
| Dental | HEALTH CARE SERVICE CORPORATION | 0 | $1.5M |
| Vision | AMERITAS LIFE INSURANCE CORP | 7,209 | $603K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 1,114 | $70K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE CO | 232 | $384K |
| Stop-loss / reinsurancereinsurance | HEALTH CARE SERVICE CORPORATION | 0 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,209 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.