| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | UNKNOWN SAN JOSE, CA 95138 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $69K | — | $69K | 6.44% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 141 W JACKSON BOULEVARD SUITE 1000 CHICAGO, IL 60605 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $20K | $1K | $21K | 1.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 6967 S RIVER GATE DRIVE, SUITE 200 SALT LAKE CITY, UT 84047 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 12.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $1K | $1K | 1.78% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 6967 S RIVER GATE DRIVE MIDVALE, UT 84047 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $2K | — | $2K | 9.32% |
| UNKNOWN3 | UNKNOWN SAN JOSE, CA 95138 | TELADOC HEALTH, INC. | $1K | $0 | $1K | 15.00% |
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 | 165 | 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) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 165 | $1.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 165 | $1.1M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 227 | $25K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 151 | $60K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 151 | $60K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 165 | $1.1M |
| Other(4 contracts, 4 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 165 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 227 | — |
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.