| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | P.O. BOX 95287 CHICAGO, IL 60694 | RELIANCE STANDARD LIFE INSURANCE CO. | $12K | $0 | $12K | 7.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 | P.O. BOX 95287 CHICAGO, IL 60694 | RELIANCE STANDARD LIFE INSURANCE CO. | $4K | $0 | $4K | 7.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 | P.O. BOX 95287 CHICAGO, IL 60694 | RELIANCE STANDARD LIFE INSURANCE CO. | $3K | $0 | $3K | 7.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCOMP ADMINISTRATORS EIN 77-0385729 CONTRACT ADMINISTRATORS | Contract Administrator; Claims processing Service code 12 | 621 SANTA FE AVENUE FRESNO, CA 93721 | $41K |
| ANTHEM BLUE CROSS EIN 95-3760980 OTHER FEES | Other fees Service code 99 | 21215 BURBANK BLVD. WOODLAND HILLS, CA 91367 | $11K |
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 | 110 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | RELIANCE STANDARD LIFE INSURANCE CO. | 110 | $55K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE CO. | 110 | $44K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE CO. | 110 | $155K |
| Stop-loss / reinsurancereinsurance | UNITED HEALTHCARE | 65 | $4K |
| Other | RELIANCE STANDARD LIFE INSURANCE CO. | 110 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 110 | — |
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.