| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 505 N BRAND BLVD STE 600 GLENDALE, CA 912030000 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $75K | $0 | $75K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $0 | $1K | $1K | 0.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 505 NORTH BRAND BLVD 6TH FL GLENDALE, CA 91203 | TRANSAMERICA LIFE INSURANCE COMPANY | $7K | $0 | $7K | 29.65% |
| MICHAEL J. RINKE3 Filed as: MICHAEL J RINKE | 2150 PICKWICK DRIVE #1116 CAMARILLO, CA 93010 | TRANSAMERICA LIFE INSURANCE COMPANY | $134 | $0 | $134 | 0.55% |
| IRINA LESNYKH3 | 5112 TOPANGA CANYON BLVD WOODLAND HILLS, CA 91364 | TRANSAMERICA LIFE INSURANCE COMPANY | $53 | $0 | $53 | 0.22% |
| RENEE SUZANNE CORSO3 Filed as: RENEE S CORSO | 5805 SEPULVEDA BLVD #700 SHERMAN OAKS, CA 91411 | TRANSAMERICA LIFE INSURANCE COMPANY | $27 | $0 | $27 | 0.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FL 6 GLENDALE, CA 912033944 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC NATI | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $313 | $313 | 1.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 333 EAST OSBORN ROAD SUITE 270 PHOENIX, AZ 85012 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | $2K | $3K | 20.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 505 NORTH BRAND BOULEVARD GLENDALE, CA 91203 | EYEMED | $1K | $0 | $1K | 9.97% |
| FMLASOURCE INC5 | 455 N CITYFRONT PLZ DR 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 20.69% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 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 NATI | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $253 | $253 | 1.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $853 | $0 | $853 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES NATI | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $178 | $178 | 2.09% |
| PAYCOM PAYROLL LLC3 | 7501 W MEMORIAL RD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $762 | $762 | 12.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $603 | $0 | $603 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC NATI | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $131 | $131 | 2.17% |
| GALLAGHER BENEFIT SERVICES, INC.4 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD STE 1000 ROLLING MEADOWS, IL 60008 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $417 | $0 | $417 | 13.14% |
| CHRISTA G AUFDEMBERG INC4 Filed as: CHRISTA G AUFDEMBERG | 13102 BRITTANY WOODS DRIVE TUSTIN, CA 92780 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $215 | $0 | $215 | 6.77% |
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 | 125 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 113 | $1.5M |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 114 | $14K |
| Vision | EYEMED | 187 | $13K |
| Life insurance(3 contracts, 2 carriers) | TRANSAMERICA LIFE INSURANCE COMPANY | 131 | $46K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 29 | $6K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 131 | $16K |
| Other(5 contracts, 4 carriers) | TRANSAMERICA LIFE INSURANCE COMPANY | 165 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 187 | — |
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.