| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | EMPIRE HEALTHCHOICE ASSURANCE, INC | $117K | $14K | $131K | 4.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 333 EAST OSBORN ROAD SUITE 27 SUITE 270 PHOENIX, AZ 85012 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | $3K | $9K | 5.22% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 NORTH BRAND BLVD 6TH FL GLENDALE, CA 91203 | MUTUAL OF OMAHA INSURANCE COMPANY | $6K | $0 | $6K | 10.00% |
| FMLASOURCE INC5 | 455 N CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | MUTUAL OF OMAHA INSURANCE COMPANY | $0 | $3K | $3K | 5.58% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 736 S STONE AVE LA GRANGE, IL 60525 | MUTUAL OF OMAHA INSURANCE COMPANY | $0 | $1K | $1K | 2.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 NORTH BRAND BLVD 6TH FL GLENDALE, CA 91203 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 736 S STONE AVE LA GRANGE, IL 60525 | MUTUAL OF OMAHA INSURANCE COMPANY | $0 | $508 | $508 | 2.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 NORTH BRAND BLVD 6TH FL GLENDALE, CA 91203 | COMPANION LIFE INSURANCE COMPANY | $979 | $0 | $979 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 736 S STONE AVE LA GRANGE, IL 60525 | COMPANION LIFE INSURANCE COMPANY | $0 | $207 | $207 | 2.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 NORTH BRAND BLVD 6TH FL GLENDALE, CA 91203 | COMPANION LIFE INSURANCE COMPANY | $660 | $0 | $660 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 736 S STONE AVE LA GRANGE, IL 60525 | COMPANION LIFE INSURANCE COMPANY | $0 | $172 | $172 | 2.61% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 NORTH BRAND BLVD 6TH FL GLENDALE, CA 91203 | MUTUAL OF OMAHA INSURANCE COMPANY | $489 | $0 | $489 | 9.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 736 S STONE AVE LA GRANGE, IL 60525 | MUTUAL OF OMAHA INSURANCE COMPANY | $0 | $104 | $104 | 2.12% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 NORTH BRAND BLVD 6TH FL GLENDALE, CA 91203 | MUTUAL OF OMAHA INSURANCE COMPANY | $66 | $0 | $66 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 736 S STONE AVE LA GRANGE, IL 60525 | MUTUAL OF OMAHA INSURANCE COMPANY | $0 | $17 | $17 | 2.58% |
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 | 248 | 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) | 248 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC | 325 | $3.2M |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 219 | $174K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 219 | $174K |
| Life insurance(2 contracts, 2 carriers) | COMPANION LIFE INSURANCE COMPANY | 272 | $15K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 272 | $61K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 272 | $24K |
| Other(5 contracts, 3 carriers) | COMPANION LIFE INSURANCE COMPANY | 272 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 325 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.