| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | LOCKBOX 95287 141 W JACKSON BLVD, STE 1000 CHICAGO, IL 606042992 | PREMERA BLUE CROSS | $122K | — | $122K | 3.23% |
| AON CONSULTING INC3 Filed as: AON RISK SERVICES INC | PO BOX 955909 SAINT LOUIS, MO 631955909 | PREMERA BLUE CROSS | $58K | — | $58K | 1.52% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 606945287 | VISION SERVICE PLAN | $1K | — | $1K | 2.85% |
| AON CONSULTING INC3 | 29840 NETWORK PLACE CHICAGO, IL 606731298 | VISION SERVICE PLAN | $1K | — | $1K | 2.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | $66 | $2K | 6.31% |
| AON CONSULTING INC3 Filed as: AON RISK SERVICES INC OF FLORIDA | 13901 SUTTON PARK DRIVE S BUILDING C, SUITE 360 JACKSONVILLE, FL 32224 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 4.96% |
| COLONIAL LIFE & ACCIDENT3 Filed as: COLONIAL LIFE & ACCIDENT INSURANCE | VARIOUS AGENTS - SEE ATTACHED POST OFFICE BOX 1365 COLUMBIA, SC 292021365 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 10.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVENUE NE SUITE 200 BELLEVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $449 | — | $449 | 5.13% |
| AON CONSULTING INC3 Filed as: AON RISK SERVICES INC OF FLORIDA | 350 N ORLEANS STREET SUITE 1446 CHICAGO, IL 60654 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $349 | — | $349 | 3.99% |
| THE ARK INSURANCE SERVICES, INC.3 Filed as: ARK INSURANCE SERVICES INC | 3740 ELIZABETH STREET RIVERSIDE, CA 92506 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $76 | — | $76 | 0.87% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVENUE NE SUITE 200 BELLEVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $354 | — | $354 | 4.90% |
| THE ARK INSURANCE SERVICES, INC.3 Filed as: ARK INSURANCE SERVICES INC | 3740 ELIZABETH STREET RIVERSIDE, CA 92506 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $252 | — | $252 | 3.49% |
| AON CONSULTING INC3 Filed as: AON RISK SERVICES INC OF FLORIDA | 350 N ORLEANS STREET SUITE 1446 CHICAGO, IL 60654 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $116 | — | $116 | 1.61% |
| COLONIAL LIFE & ACCIDENT3 Filed as: COLONIAL LIFE & ACCIDENT INSURANCE | VARIOUS AGENTS - SEE ATTACHED POST OFFICE BOX 1365 COLUMBIA, SC 292021365 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $931 | — | $931 | 15.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVENUE NE BELLEVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $88 | — | $88 | 4.71% |
| THE ARK INSURANCE SERVICES, INC.3 Filed as: ARK INSURANCE SERVICES INC | 3740 ELIZABETH STREET RIVERSIDE, CA 92506 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $71 | — | $71 | 3.80% |
| AON CONSULTING INC3 Filed as: AON RISK SERVICES INC. OF FLORIDA | 350 N ORLEANS STREET SUITE 1446 CHICAGO, IL 60654 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $27 | — | $27 | 1.45% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVENUE NE SUITE 200 BELLEVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $57 | — | $57 | 5.06% |
| AON CONSULTING INC3 Filed as: AON RISK SERVICES INC OF FLORIDA | 350 N ORLEANS STREET SUITE 1446 CHICAGO, IL 60654 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $44 | — | $44 | 3.90% |
| THE ARK INSURANCE SERVICES, INC.3 Filed as: ARK INSURANCE SERVICES INC | 3740 ELIZABETH STREET RIVERSIDE, CA 92506 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11 | — | $11 | 0.98% |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $529 | $529 | — |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $57 | $57 | — |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $86 | $86 | — |
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 | 483 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 487 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 540 | $3.8M |
| Dental(2 contracts, 2 carriers) | PREMERA BLUE CROSS | 540 | $3.8M |
| Vision(3 contracts, 2 carriers) | VISION SERVICE PLAN | 293 | $38K |
| Life insurance(6 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 71 | $57K |
| Short-term disability(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 27 | $21K |
| Long-term disability(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 27 | $21K |
| Prescription drug | PREMERA BLUE CROSS | 540 | $3.8M |
| Other(7 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 71 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 540 | — |
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.