| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $74K | $0 | $74K | 2.49% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $9K | $948 | $10K | 5.48% |
| 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 | 10.00% |
| ADP INC5 Filed as: AUTOMATIC DATA PROCESSING INC | PO BOX 842875 BOSTON, MA 05584 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $6K | $6K | 4.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $4K | $4K | 3.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | $3K | $0 | $3K | 8.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 NORTH BRAND BLVD GLENDALE, CA 91203 | TRANSAMERICA LIFE INSURANCE COMPANY | $12K | $0 | $12K | 35.69% |
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 | 317 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 321 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 651 | $3.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 256 | $186K |
| Vision(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 651 | $3.0M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 316 | $121K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 316 | $121K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 316 | $121K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 651 | $3.0M |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 316 | $155K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 651 | — |
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.