| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 501 FELLOWSHIP RD STE 201 MT LAUREL, NJ 08054 | AETNA LIFE INSURANCE CO. | — | $11K | $11K | 2.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 501 FELLOWSHIP RD STE 201 MT LAUREL, NJ 08054 | AETNA LIFE INSURANCE CO. | — | $2K | $2K | 0.43% |
| PAUL D GIESE3 | 5602 NEEDVILLE ST SAN ANTONIO, TX 78233 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23K | $305 | $24K | 10.26% |
| HORIZON BENEFITS LLC3 | 9385 MILLER LANE GARDEN RIDGE, TX 78266 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $4K | $8K | 3.34% |
| SA GENERAL AGENCY INC3 | 9385 MILLER LANE GARDEN RIDGE, TX 78266 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $1K | $3K | 1.28% |
| GARY P QUANDT3 | 3206 YORKTOWN DR SAN ANTONIO, TX 78230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $204 | $2K | 1.04% |
| KELLY MELISSA KRISCH3 | 725 RIVER BLUFF DRIVE LYTLE, TX 78052 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $452 | $2K | 0.96% |
| CYNTHIA K STYRON3 | 232 SAWGRASS SPRING BRANCH, TX 78070 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 0.89% |
| PATRICIA L WEGNER3 | 5445 COUNTY ROAD 5710 DEVINE, TX 78016 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $8 | $1K | 0.57% |
| BILLY MARK ROBERSON3 | 17415 SHADY CANYON SAN ANTONIO, TX 78248 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $357 | $4 | $361 | 0.16% |
| GALE SIMPSON3 | 1830 CONNIE DRIVE CANYON LAKE, TX 78133 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $337 | $13 | $350 | 0.15% |
| OMAR MENDOZA3 | 26326 ROCKWALL PKWY NEW BRAUNFELS, TX 78132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $297 | $1 | $298 | 0.13% |
| KIMBERLY BRIDGETTE VECCHIO-WALKER3 | 8902 DRAYTON HEIGHTS SAN ANTONIO, TX 78254 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $127 | $1 | $128 | 0.06% |
| LES MILLER3 | 2249 INDUSTRIAL BLVD ABILENE, TX 79602 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | — | $23 | 0.01% |
| N PAULINE FERRELL3 | 286 THOROUGHBRED SPRING BRANCH, TX 78070 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.01% |
| TROY J PALMER3 | 15534 CLOVER RDG SAN ANTONIO, TX 78248 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.01% |
| TRACY HENRY3 Filed as: TRACY HENRY INC | 3005 SOFTWOOD CIRCLE KELLER, TX 76244 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1900 W LOOP S STE 1600 HOUSTON, TX 77027 | AETNA LIFE INSURANCE CO. | -$18K | — | -$18K | -30.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $616 | $616 | 1.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 2 PIERCE PL 21ST FL ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $755 | — | $755 | 10.52% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $229 | — | $229 | 3.19% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | INC - KANSAS CITY TWO PIERCE PL 21ST FL ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $206 | — | $206 | 2.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVE HARTFORD, CT 06156 | $284K |
| AETNA BEHAVIORAL HEALTH, LLC EIN 20-0446713 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 151 FARMINGTON AVE RSAA HARTFORD, CT 06156 | $17K |
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 | 755 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 14 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 769 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 278 | $287K |
| Dental | AETNA LIFE INSURANCE CO. | 1,064 | $379K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 850 | $41K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 755 | $279K |
| Short-term disability(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 1,064 | $609K |
| Long-term disability(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 1,064 | $386K |
| Stop-loss / reinsurancereinsurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 612 | $432K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 755 | $279K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,064 | — |
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.