| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | PACIFICSOURCE HEALTH PLANS | $151K | — | $151K | 5.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $46K | — | $46K | 20.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 1.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | VISION SERVICE PLAN | $2K | — | $2K | 2.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 10505 SORRENTO VALLEY ROAD SAN DIEGO, CA 92121 | TRANSAMERICA LIFE INSURANCE COMPANY | $5K | — | $5K | 10.00% |
| THE BOON INSURANCE AGENCY3 Filed as: THE BOON INSURANCE AGENCY, INC. | 6300 BRIDGEPOINT PARKWAY BUILDING 3, SUITE 500 AUSTIN, TX 78730 | TRANSAMERICA LIFE INSURANCE COMPANY | $4K | — | $4K | 8.00% |
| GALALGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | VISION SERVICE PLAN | $1K | — | $1K | 5.73% |
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 | 2,403 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,414 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PACIFICSOURCE HEALTH PLANS | 435 | $3.0M |
| Dental | PACIFICSOURCE HEALTH PLANS | 435 | $2.9M |
| Vision(2 contracts) | VISION SERVICE PLAN | 427 | $96K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,403 | $276K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,403 | $230K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,403 | $230K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 435 | $2.9M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,403 | $276K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,403 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.