| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 600 HIGHWAY 169 SOUTH, SUITE 1200 SAINT LOUIS PARK, MN 55426 | AETNA LIFE INSURANCE COMPANY | — | $1K | $1K | 1.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 8561 MARKET STREET YOUNGSTOWN, OH 44513 | AETNA LIFE INSURANCE COMPANY | — | $67 | $67 | 0.07% |
| WELLS FARGO INSURANCE SERVICES3 | 1301 EAST 9TH STREET, SUITE 3800 CLEVELAND, OH 44114 | VISION SERVICE PLAN | $871 | — | $871 | 6.51% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203417 DALLAS, TX 75320 | VISION SERVICE PLAN | $700 | — | $700 | 5.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 1301 EAST 9TH STREET, SUITE 3800 CLEVELAND, OH 44114 | VISION SERVICE PLAN | $101 | — | $101 | 0.85% |
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 | 140 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 148 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM | 140 | $0 |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 142 | $56K |
| Vision(2 contracts) | VISION SERVICE PLAN | 100 | $25K |
| Life insurance | AETNA LIFE INSURANCE COMPANY | 182 | $97K |
| Short-term disability | AETNA LIFE INSURANCE COMPANY | 182 | $97K |
| Long-term disability | AETNA LIFE INSURANCE COMPANY | 182 | $97K |
| Prescription drug | ANTHEM | 140 | $0 |
| Other | AETNA LIFE INSURANCE COMPANY | 182 | $97K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 182 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.