| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES | 2850 GOLF RD 5TH FLR ROLLING MEADOWS, IL 60008 | SYMETRA LIFE INSURANCE COMPANY | — | $10K | $10K | 2.03% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES | 4280 SERGEANT RD, STE 200 SIOUX CITY, IA 51106 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 1.97% |
| SELECT NETWORKS | 6165 NW 86TH STREET, SUITE 108 JOHNSTON, IA 50131 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 11.55% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES, INC | 1 WEST 4TH STREET, SUITE 1300 CINCINNATI, OH 45202 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 10.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARMACY BENEFIT MGMT. | Other fees; Direct payment from the plan; Claims processing; Float revenue Service code 12 | 2300 MAIN ST IRVINE, CA 92614 | $1.0M |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | 11 SCOTT ST WAUSAU, WI 54403 | $136K |
| THREE RIVERS BENEFIT CORP EIN 13-5123390 NONE | Contract Administrator Service code 13 | 518 8TH STREET SIOUX CITY, IA 51102 | $5K |
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 | 536 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 536 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF IOWA | 250 | $164K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 388 | $19K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 536 | $134K |
| Long-term disability(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 536 | $134K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 252 | $478K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 536 | $134K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 536 | — |
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."
No prospect flags tripped on this filing.