| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 160 WEST SANTA CLARA STREET SAN JOSE, CA 95113 | AETNA HEALTH OF CALIFORNIA, INC. | $19K | $0 | $19K | 2.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | KAISER FOUNDATION HEALTH PLAN, INC. | $11K | $0 | $11K | 2.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 160 WEST SANTA CLARA STREET SAN JOSE, CA 95113 | AETNA LIFE INSURANCE COMPANY | $7K | $3K | $10K | 3.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $1K | $1K | 1.76% |
| LTC SOLUTIONS, INC.3 | 14715 NE 95TH STREET, SUITE 200 REDMOND, WA 98052 | THRIVENT | $6K | $0 | $6K | 24.39% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | THRIVENT | $2K | $0 | $2K | 8.50% |
| LTC SOLUTIONS, INC.3 | 14715 NE 95TH STREET, SUITE 200 REDMOND, WA 98052 | MEDAMERICA | $667 | $0 | $667 | 4.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | MEDAMERICA | $222 | $0 | $222 | 1.57% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | UNUM INSURANCE COMPANY | $1K | $0 | $1K | 14.79% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNUM INSURANCE COMPANY | $0 | $178 | $178 | 1.92% |
| LTC SOLUTIONS, INC.3 | 14715 NE 95TH STREET, SUITE 200 REDMOND, WA 98052 | MUTUAL OF OMAHA | $201 | $0 | $201 | 4.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | MUTUAL OF OMAHA | $130 | $0 | $130 | 2.75% |
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 | 88 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 90 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA HEALTH OF CALIFORNIA, INC. | 87 | $1.5M |
| Dental | DELTA DENTAL OF CALIFORNIA | 174 | $82K |
| Vision | VISION SERVICE PLAN | 76 | $11K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 90 | $74K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 90 | $74K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 90 | $74K |
| Prescription drug(3 contracts, 3 carriers) | AETNA HEALTH OF CALIFORNIA, INC. | 87 | $1.5M |
| Other(6 contracts, 6 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 91 | $131K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
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."
No prospect flags tripped on this filing.