| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | UNITED HEALTHCARE INSURANCE COMPANY | $7K | — | $7K | 1.37% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SVCS. OF CA, INC. | 4250 EXECUTIVE SQUARE, SUITE 900 LA JOLLA, CA 92037 | UNITED HEALTHCARE INSURANCE COMPANY | $5K | — | $5K | 0.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | METROPOLITAN LIFE INSURANCE COMPANY | $728 | $222 | $950 | 6.68% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SVCS. OF CA, INC. | 4250 EXECUTIVE SQUARE, SUITE 900 LA JOLLA, CA 92037 | METROPOLITAN LIFE INSURANCE COMPANY | $613 | $214 | $827 | 5.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | SAFEGUARD HEALTH PLANS, INC. | $521 | $104 | $625 | 5.85% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SVCS. OF CA, INC. | 4250 EXECUTIVE SQUARE, SUITE 900 LA JOLLA, CA 92037 | SAFEGUARD HEALTH PLANS, INC. | $438 | $88 | $526 | 4.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | TWO PIERCE PLACE, 21ST FL ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 18.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | 2850 W GOLF ROAD, 11TH FL ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $142 | $142 | 2.51% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | TWO PIERCE PLACE, 21ST FL ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 21.05% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | 2580 W GOLF ROAD, 11TH FL ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $129 | $129 | 2.60% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | TWO PIERCE PLACE, 21ST FL ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $925 | — | $925 | 20.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | 2850 W GOLF ROAD, 11TH FL ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $114 | $114 | 2.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | TWO PIERCE PLACE, 21ST FL ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $870 | — | $870 | 19.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | 2850 W GOLF ROAD, 11TH FL ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $82 | $82 | 1.80% |
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 | 110 | 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) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 63 | $520K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 140 | $25K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 132 | $14K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 110 | $15K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 18 | $5K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 110 | $5K |
| Prescription drug | UNITED HEALTHCARE INSURANCE COMPANY | 63 | $520K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 110 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 140 | — |
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."
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.