| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $3K | $420 | $3K | 5.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 11060 WHITE ROCK ROAD, SUITE 160 RANCHO CORDOVA, CA 95670 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $0 | $1K | 15.00% |
| DAWN D SHEUE3 Filed as: DAWN D. SHEUE | PO BOX 3986 JACKSON, WY 83001 | AFLAC | $9 | $0 | $9 | 3.86% |
| THOMAS E SHEUE3 Filed as: THOMAS E. SHEUE | PO BOX 3986 JACKSON, WY 83001 | AFLAC | $9 | $0 | $9 | 3.86% |
| DEANNA M CHRISTENSEN3 Filed as: DEANNA M. CHRISTENSEN | PO BOX 2175 ROCK SPRINGS, WY 82902 | AFLAC | $4 | $0 | $4 | 1.72% |
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 | 101 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 102 | $57K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 102 | $57K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 101 | $9K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 101 | $9K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 101 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 102 | — |
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.