| 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. | $15K | $3K | $18K | 2.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | KAISER FOUNDATION HEALTH PLAN INC | $10K | $0 | $10K | 2.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 160 WEST SANTA CLARA STREET SAN JOSE, CA 95113 | AETNA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 2.27% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $991 | $991 | 1.25% |
| LTC SOLUTIONS, INC.3 | 14715 NE 95TH STREET, SUITE 200 REDMOND, WA 98052 | MEDAMERICA | $943 | $0 | $943 | 5.84% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE,S INC. | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | MEDAMERICA | $314 | $0 | $314 | 1.94% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | UNUM INSURANCE COMPANY | $1K | $0 | $1K | 13.22% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM INSURANCE COMPANY | $0 | $212 | $212 | 2.29% |
| LTC SOLUTIONS, INC.3 | 14715 NE 95TH STREET, SUITE 200 REDMOND, WA 98052 | MUTUAL OF OMAHA | $425 | $0 | $425 | 6.75% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE,S INC. | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | MUTUAL OF OMAHA | $142 | $0 | $142 | 2.26% |
| LTC SOLUTIONS, INC.3 | 14715 NE 95TH STREET, SUITE 200 REDMOND, WA 98052 | PRUDENTIAL | $75 | $0 | $75 | 3.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE,S INC. | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | PRUDENTIAL | $25 | $0 | $25 | 1.00% |
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 | 97 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 99 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | AETNA HEALTH OF CALIFORNIA, INC. | 99 | $1.4M |
| Dental | DELTA DENTAL OF CALIFORNIA | 211 | $93K |
| Vision | VISION SERVICE PLAN | 90 | $12K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $79K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $79K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $79K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 87 | $724K |
| Other(6 contracts, 6 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 107 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 211 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.