| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | ATT SANDY EHMKE 2850 GOLF RD ROLLING MDWS, IL 60008 | AETNA LIFE INSURANCE COMPANY | $166K | — | $166K | 3.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | ATTN SANDY EHMKE 2850 GOLF RD ROLLING MDWS, IL 60008 | AETNA LIFE INSURANCE COMPANY | $0 | $16K | $16K | 0.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 | ATTN SANDY EHMKE 2850 GOLF RD ROLLING MDWS, IL 60008 | AETNA LIFE INSURANCE COMPANY | $0 | $46 | $46 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 250 PARK AVENUE 3RD FLOOR NEW YORK, NY 10177 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $8K | $2K | $10K | 12.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 250 PARK AVENUE 3RD FLOOR NEW YORK, NY 10177 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $2K | $5K | 9.54% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. - NY | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK | $1K | — | $1K | 4.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 250 PARK AVENUE 3RD FLOOR NEW YORK, NY 10177 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $763 | $3K | 12.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 250 PARK AVENUE 3RD FLOOR NEW YORK, NY 10177 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $400 | $116 | $516 | 12.89% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. - NY | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK | $64 | — | $64 | 4.35% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. - NY | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK | $8 | — | $8 | 4.32% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WEX HEALTH, INC., A WEX COMPANY NONE | Contract Administrator; Claims processing Service code 12 | 4321 20TH AVE S FARGO, ND 58103 | $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 | 303 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 72 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 383 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 489 | $4.3M |
| Dental | AETNA LIFE INSURANCE COMPANY | 489 | $4.3M |
| Vision(3 contracts) | FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK | 407 | $31K |
| Life insurance | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 303 | $82K |
| Short-term disability | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 163 | $51K |
| Long-term disability | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 142 | $26K |
| Other(3 contracts) | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 303 | $137K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 489 | — |
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.