| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 18201 VON KARMAN AVE SUITE 200 IRVINE, CA 926121069 | METROPOLITAN LIFE INSURANCE COMPANY | $42K | $54 | $42K | 13.70% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $4K | $4K | 1.47% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 606945287 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $9 | $9 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 606945287 | VISION SERVICE PLAN | $2K | — | $2K | 2.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | EMPLOYERS DENTAL SERVICES (PRINCIPAL) | $451 | — | $451 | 4.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | ALPHA DENTAL OF ARIZONA INC | $394 | — | $394 | 4.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMINISTRATION | Non-monetary compensation; Named fiduciary; Float revenue; Claims processing; Participant communication; Other services; Direct payment from the plan; Contract Administrator Service code 12 | — | $595K |
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 | 833 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 833 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(3 contracts, 3 carriers) | DELTA DENTAL OF ARIZONA | 1,012 | $419K |
| Vision | VISION SERVICE PLAN | 536 | $71K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,106 | $305K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,106 | $305K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,106 | $305K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,052 | $865K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 1,106 | $305K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,106 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.