| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $80K | $0 | $80K | 4.58% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 500 N SANTA FE VISALIA, CA 93292 | CALIFONIA PHYSICIANS' SERVICE | $0 | $57K | $57K | 4.86% |
| GAALAGHER BENEFIT SERVICES INC3 | — | AETNA LIFE INSURANCE COMPANY | $8K | $0 | $8K | 3.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | AETNA LIFE INSURANCE COMPANY | $5K | $0 | $5K | 2.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 21ST FLOOR ARLINGTON HEIGHTS, IL 60006 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $0 | $5K | 12.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BLVD GLENDALE, CA 91203 | EYEMED VISION CARE | $3K | $0 | $3K | 9.06% |
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 | 458 | 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) | 458 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 342 | $2.9M |
| Dental | AETNA LIFE INSURANCE COMPANY | 634 | $254K |
| Vision | EYEMED VISION CARE | 596 | $34K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 480 | $40K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 480 | $40K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 480 | $40K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 342 | $2.9M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 480 | $52K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 634 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.