| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | BLUE CROSS OF CALIFORNIA | $55K | $2K | $58K | 5.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $444 | $444 | 0.81% |
| PAYCOM PAYROLL LLC5 | 7501 W MEMORIAL RD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $4K | $4K | 31.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $302 | $302 | 2.35% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 NORTH BRAND BLVD SUITE 100 FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOW, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $242 | $242 | 1.94% |
| PAYCOM PAYROLL LLC5 | 7501 W MEMORIAL RD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $4K | $4K | 39.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $220 | $220 | 2.16% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $989 | $0 | $989 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $202 | $202 | 2.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $838 | $0 | $838 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $213 | $213 | 2.54% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 NORTH BRAND BLVD 6TH FL GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $609 | $0 | $609 | 10.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOW, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $117 | $117 | 1.92% |
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 | 121 | 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) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 178 | $1.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 108 | $55K |
| Vision | BLUE CROSS OF CALIFORNIA | 178 | $1.1M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $6K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 39 | $10K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $13K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 178 | — |
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.