| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2019 N ELIZABETH DR ARLINGTON HEIGHTS, IL 60004 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $85K | $12K | $97K | 1.42% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | THE STANDARD INSURANCE COMPANY | $78K | — | $78K | 18.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | THE STANDARD INSURANCE COMPANY | $37K | — | $37K | 20.55% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | THE STANDARD INSURANCE COMPANY | $32K | — | $32K | 20.36% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | THE STANDARD INSURANCE COMPANY | $71K | — | $71K | 71.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 6325 RANCH DRIVE LITTLE ROCK, AR 72223 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 11.22% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | P.O BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $162 | $126 | $288 | 1.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 285 W GOLF RD ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $258 | $258 | 1.54% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 6325 RANCH DRIVE LITTLE ROCK, AR 72223 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $887 | — | $887 | 9.88% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | P.O BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $83 | $83 | $166 | 1.85% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $119 | $119 | 1.33% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | P.O BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $294 | $134 | $428 | 8.89% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 6325 RANCH DRIVE LITTLE ROCK, AR 72223 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $100 | — | $100 | 2.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 285 W GOLF RD ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $4 | $4 | 0.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD GBS FINANCE - 5TH FLOOR ROLLING MEADOWS, IL 60008 | NEW YORK LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $16 | $16 | 1.89% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | P.O BOX 101162 PASADENA, CA 91189 | NEW YORK LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $36 | $36 | 8.31% |
No Schedule C service providers reported on this filing.
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 | 1,109 | 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) | 1,109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,662 | $6.8M |
| Dental | DELTA DENTAL PLAN OF ARKANSAS | 1,710 | $412K |
| Vision | AETNA LIFE INSURANCE CO. | 1,666 | $93K |
| Life insurance(2 contracts, 2 carriers) | THE STANDARD INSURANCE COMPANY | 1,109 | $432K |
| Short-term disability(3 contracts, 3 carriers) | THE STANDARD INSURANCE COMPANY | 984 | $165K |
| Long-term disability(3 contracts, 2 carriers) | THE STANDARD INSURANCE COMPANY | 612 | $204K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,662 | $6.8M |
| Other(2 contracts, 2 carriers) | TELUS HEALTH (US) LTD. | 1,050 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,710 | — |
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.