| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | HEALTHPARTNERS INSURANCE COMPANY | — | $84 | $84 | 0.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 3600 AMERICAN BOULEVARD W, SUITE 500 BLOOMINGTON, MN 55431 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 12.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $858 | $858 | 2.54% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 3600 AMERICAN BOULEVARD W, SUITE 500 BLOOMINGTON, MN 55431 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 12.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $420 | $420 | 1.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 3600 AMERICAN BOULEVARD W, SUITE 500 BLOOMINGTON, MN 55431 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.83% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $171 | — | $171 | 1.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | $610 | — | $610 | 5.49% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | VISION SERVICE PLAN | $390 | — | $390 | 3.51% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 3600 AMERICAN BOULEVARD W, SUITE 500 BLOOMINGTON, MN 55431 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $835 | — | $835 | 10.85% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $88 | — | $88 | 1.14% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 3600 AMERICAN BOULEVARD W, SUITE 500 BLOOMINGTON, MN 55431 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $637 | — | $637 | 12.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $64 | $64 | 1.21% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 3600 AMERICAN BOULEVARD W, SUITE 500 BLOOMINGTON, MN 55431 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $573 | — | $573 | 10.81% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $63 | — | $63 | 1.19% |
| STEVE BAKER4 | 153 ESTHER DRIVE COCOA BEACH, FL 32931 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $3K | — | $3K | 121.95% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREFERREDONE ADMIN. SERVICES, INC. EIN 41-1846481 ADMINISTRATOR | Contract Administrator Service code 13 | — | $48K |
| ASCENSUS HEALTH & BENEFIT COMPANIES ADMINISTRATOR | Contract Administrator Service code 13 | 200 DRYDEN ROAD DRESHER, PA 19025 | $9K |
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 | 209 | 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) | 209 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | HEALTHPARTNERS INSURANCE COMPANY | 311 | $130K |
| Vision | VISION SERVICE PLAN | 121 | $11K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 310 | $32K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 128 | $34K |
| Other(5 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 308 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 311 | — |
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.