| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 6967 SOUTH RIVER GATE DRIVE SUITE 200 MIDVALE, UT 84047 | SELECTHEALTH | $12K | $5K | $17K | 3.19% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 6967 SOUTH RIVER GATE DRIVE SUITE 200 SALT LAKE CITY, UT 84047 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 6.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $806 | $806 | 2.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 6967 SOUTH RIVER GATE DRIVE SUITE 200 SALT LAKE CITY, UT 84047 | DELTA DENTAL INSURANCE COMPANY | $2K | $0 | $2K | 6.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 6967 SOUTH RIVER GATE DRIVE MIDVALE, UT 84047 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $349 | $0 | $349 | 9.91% |
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 | 35 | 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) | 35 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SELECTHEALTH | 66 | $522K |
| Dental | DELTA DENTAL INSURANCE COMPANY | 73 | $28K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 52 | $4K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 31 | $36K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 31 | $36K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 31 | $36K |
| Prescription drug | SELECTHEALTH | 66 | $522K |
| Other(2 contracts, 2 carriers) | SELECTHEALTH | 66 | $558K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 73 | — |
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.