| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J GALLAGHER & CO INS | 2850 GOLF RD, STE 1000 ROLLING MEADOWS, IL 60008 | BLUE CROSS OF CALIFORNIA | $59K | — | $59K | 3.53% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC. | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | BLUE CROSS OF CALIFORNIA | $12K | — | $12K | 0.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVE STE 200 IRVINE, CA 92612 | METROPOLITAN LIFE INSURANCE COMPANY | $13K | $54 | $13K | 8.10% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY SE SUITE 1950 ATLANTA, GA 30339 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $365 | $3K | 2.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 1.12% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 1111 SUPERIOR AVE E STE 1601 CLEVELAND, OH 44114 | METROPOLITAN LIFE INSURANCE COMPANY | — | $19 | $19 | 0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BLVD 6TH FLOOR GLENDALE, CA 91203 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 8.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 | ONE COMMERCE SQUARE STE 820 2005 MARKET STREET PHILADELPHIA, PA 19103 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 2.11% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, INC. | 900 HOWE AVENUE, SUITE 220 SACRAMENTO, CA 95825 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 1.82% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $56 | $56 | 0.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 505 NORTH BRAND BLVD, 6TH FLOOR GLENDALE, CA 91203 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $8K | — | $8K | 26.48% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | — | $747 | $747 | 2.43% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY SE SUITE 1950 ATLANTA, GA 30339 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $191 | — | $191 | 0.62% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVE STE 200 IRVINE, CA 92612 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $104 | — | $104 | 8.60% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY SE SUITE 1950 ATLANTA, GA 30339 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $16 | $2 | $18 | 1.49% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | — | $14 | $14 | 1.16% |
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 | 202 | 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) | 202 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 255 | $1.7M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 404 | $166K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 404 | $164K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 325 | $133K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 325 | $133K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 325 | $133K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 255 | $1.7M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 325 | $163K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 404 | — |
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.