| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE DRIVE NEWPORT BEACH, CA 92660 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $39K | $2K | $41K | 4.20% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE DRIVE NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN INC. | $17K | — | $17K | 5.87% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE DRIVE NEWPORT BEACH, CA 92660 | GUARDIAN | $8K | $8K | $17K | 9.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE DRIVE NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $308 | $3K | 16.88% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE DRIVE NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $270 | $2K | 16.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE DRIVE NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $122 | $122 | 2.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE DRIVE NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $728 | $86 | $814 | 16.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT BEACH DRIVE NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $32 | $32 | — |
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 | 136 | 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) | 136 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 77 | $1.3M |
| Dental | GUARDIAN | 123 | $172K |
| Vision | GUARDIAN | 123 | $172K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 136 | $22K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 160 | $14K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 77 | $289K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 136 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 160 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.