| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 141 WEST JACKSON BOULEVARD SUITE 1000 CHICAGO, IL 60604 | PREMERA BLUE CROSS | $123K | $0 | $123K | 4.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60604 | PREMERA BLUE CROSS | $0 | $30K | $30K | 1.19% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | METROPOLITAN LIFE INSURANCE COMPANY | $25K | $0 | $25K | 19.67% |
| CONNEXION INSURANCE SOLUTIONS3 Filed as: CONNEXION PREMERA | PO BOX 743979 LOS ANGELES, CA 90074 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $0 | $6K | 4.58% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60604 | VISION SERVICE PLAN | $3K | $0 | $3K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | VISION SERVICE PLAN | -$206 | $0 | -$206 | -0.78% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $794 | $0 | $794 | 19.72% |
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 | 307 | 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) | 307 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 311 | $2.5M |
| Dental | PREMERA BLUE CROSS | 311 | $2.5M |
| Vision | VISION SERVICE PLAN | 197 | $26K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 307 | $126K |
| Long-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 307 | $130K |
| Prescription drug | PREMERA BLUE CROSS | 311 | $2.5M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 307 | $126K |
| 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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.