| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 5420 LBJ FREEWAY SUITE 400 DALLAS, TX 75240 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $83K | — | $83K | 4.74% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 16200 ADDISON ROAD SUITE 270 ADDISON, TX 75001 | KAISER FOUNDATION HEALTH PLAN INC. | $38K | — | $38K | 3.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 5420 LBJ FREEWAY SUITE 400 DALLAS, TX 75240 | VISION SERVICE PLAN | $6K | — | $6K | 1.57% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2 PIERCE PLACE ITASCA, IL 60143 | HYATT LEGAL PLANS | $6K | — | $6K | 11.24% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 101 LARKSPUR LANDING CIRCLE SUITE 120 LARKSPUR, CA 94939 | HYATT LEGAL PLANS | — | $1K | $1K | 2.17% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 VENDOR | Claims processing Service code 12 | — | $463K |
| GALLAGHER BENEFIT SERVICES, INC. EIN 36-4291971 VENDOR | Insurance agents and brokers Service code 22 | — | $48K |
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 | 1,281 | 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) | 1,281 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 1,023 | $2.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,023 | $1.7M |
| Vision | VISION SERVICE PLAN | 1,164 | $354K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 1,023 | $2.2M |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,023 | $949K |
| Other | HYATT LEGAL PLANS | 266 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,164 | — |
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.