| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 505 N BRAND BLVD STE 100 GLENDALE, CA 91203 | KAISER FOUNDATION HEALTH PLAN | $40K | $0 | $40K | 4.76% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2850 GOLF ROAD 5TH FL ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | $552 | $7K | 10.88% |
| FMLASOURCE INC5 | 455 N CITYFRONT PLZ DR 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 24.40% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NATIONAL INCENTIVE 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $327 | $327 | 2.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $974 | $0 | $974 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | NATIONAL INCENTIVE 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $230 | $230 | 2.36% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES - GLENDA | 505 NORTH BRAND BLVD STE 600 GLENDALE, CA 91203 | EYEMED VISION CARE | $648 | $0 | $648 | 9.15% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $523 | $0 | $523 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | NATIONAL INCENTIVE 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $127 | $127 | 2.43% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $796 | $0 | $796 | 20.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NATIONAL INCENTIVE 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $10 | $10 | 0.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $398 | $0 | $398 | 10.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NATIONAL INCENTIVE 736 S STONE AVE LA GRANGE, IA 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $116 | $116 | 2.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $297 | $0 | $297 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | NATIONAL INCENTIVE 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $7 | $7 | 0.24% |
| TELUS HEALTH (US) LTD.3 | 250 ROYALL STREET STE 210W CANTON, MA 02021 | TELUS HEALTH (US) LTD. | $0 | $5K | $5K | — |
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 | 200 | 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) | 200 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN | 88 | $850K |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 61 | $62K |
| Vision | EYEMED VISION CARE | 100 | $7K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 169 | $23K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 16 | $5K |
| Other(5 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 180 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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.