| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 NORTH BRAND BLVD 6TH FL GLENDALE, CA 91203 | BLUE CROSS OF CALIFORNIA | $80K | $807 | $81K | 4.60% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 500 NORTH BRAND BOULEVARD STE 100 GLENDALE, CA 91203 | KAISER FOUNDATION HEALTH PLAN INC. | $37K | $0 | $37K | 3.37% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 21820 BURBANK BLVD STE 300 WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC. | $8K | $0 | $8K | 0.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $17K | $0 | $17K | 9.93% |
| 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 | $12K | $0 | $12K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 736 S STONE AVE 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 2.76% |
| 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 | $9K | $0 | $9K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 2.77% |
| PAYCOM PAYROLL LLC5 | 7501 W MEMORIAL RD OKLAHHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $10K | $10K | 17.25% |
| 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 | $9K | $0 | $9K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 3.04% |
| 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 | $7K | $0 | $7K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 736 S STONE AVE 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 2.82% |
| PAYCOM PAYROLL LLC5 | 7501 W MEMORIAL RD OKLAHHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $10K | $10K | 26.40% |
| 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 | $6K | $0 | $6K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 2.95% |
| 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 | $5K | $0 | $5K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 3.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF ROAD ROLLING MEADOWS, IL 60008 | VISION SERVICE PLAN | $2K | $0 | $2K | 4.96% |
| 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 | $6K | $0 | $6K | 20.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $911 | $911 | 2.97% |
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 | 418 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 423 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 185 | $2.9M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 365 | $169K |
| Vision | VISION SERVICE PLAN | 354 | $31K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 417 | $118K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 174 | $44K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 414 | $62K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 185 | $2.9M |
| Other(5 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 417 | $244K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 417 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.