| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 100 SMITH RANCH ROAD, SUITE 112 SAN RAFAEL, CA 94903 | CALIFORNIA PHYSICIANS SERVICE | $232K | $15K | $247K | 3.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | METROPOLITAN LIFE INSURANCE COMPANY | $26K | $8K | $35K | 5.31% |
| LIAZON BENEFITS INC3 Filed as: LIAZON BENEFITS, INC. | 199 SCOTT STREET, 8TH FLOOR BUFFALO, NY 14204 | METROPOLITAN LIFE INSURANCE COMPANY | $26K | $0 | $26K | 4.05% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3900 ARLINGTON, IL 60006 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $60K | $0 | $60K | 15.00% |
| LIAZON BENEFITS INC3 Filed as: LIAZON BENEFITS, INC. | 199 SCOTT STREET, 8TH FLOOR BUFFALO, NY 14204 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $20K | $0 | $20K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 400 MIDLAND DRIVE, SUITE 300 MOUNT LAUREL, NJ 08054 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 0.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 71542 CHICAGO, IL 60695 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $21K | $0 | $21K | 14.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $18K | $0 | $18K | 12.48% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | VISION SERVICE PLAN | $7K | $0 | $7K | 9.99% |
| LIAZON BENEFITS INC3 Filed as: LIAZON BENEFITS, INC. | 199 SCOTT STREET BUFFALO, NY 14204 | VISION SERVICE PLAN | $4K | $0 | $4K | 4.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | SAFEGUARD HEALTH PLANS, INC.,A CALIFORNIA CORPORATION | $2K | $663 | $3K | 5.85% |
| LIAZON BENEFITS INC3 Filed as: LIAZON BENEFITS, INC. | 199 SCOTT STREET, 8TH FLOOR BUFFALO, NY 14204 | SAFEGUARD HEALTH PLANS, INC.,A CALIFORNIA CORPORATION | $2K | $0 | $2K | 4.43% |
| LIAZON BENEFITS INC3 Filed as: LIAZON BENEFITS, INC. | 199 SCOTT STREET, 8TH FLOOR BUFFALO, NY 14204 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY | $2K | $3K | $5K | 24.36% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | U.S. BEHAVIORAL HEALTH PLAN, CALIFORNIA DBA OPTUM | $2K | $0 | $2K | 14.95% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6 | $181 | $187 | 6.01% |
| LOUIS R FAIOLA3 Filed as: LOUIS JOSEPH PANTALONE | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $73 | $0 | $73 | 2.35% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $32 | $0 | $32 | 1.03% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 71542 CHICAGO, IL 60695 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $122 | $0 | $122 | 5.42% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $101 | $0 | $101 | 4.49% |
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 | 702 | 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) | 702 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS SERVICE | 1,430 | $7.9M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 993 | $699K |
| Vision | VISION SERVICE PLAN | 666 | $75K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 988 | $397K |
| Short-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 988 | $400K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 988 | $397K |
| Prescription drug | CALIFORNIA PHYSICIANS SERVICE | 1,430 | $7.9M |
| Other(6 contracts, 5 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 988 | $582K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,430 | — |
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.