| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC. | — | CIGNA HEALTH & LIFE INSURANCE COMPANY | $38K | — | $38K | 6.46% |
| BOLLINGER INC | — | CIGNA HEALTH & LIFE INSURANCE COMPANY | $22K | — | $22K | 3.69% |
| GALLAGHER BENEFIT SERVICES, INC. | 35 WATERVIEW BLVD. SUITE 300 PARSIPPANY, NJ 07054 | DELTA DENTAL OF NEW JERSEY INC | — | — | $0 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLGHER BENEFIT SERVICES, INC | 2850 GOLF RD 5TH FL ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 9.18% |
| GALLAGHER BENEFIT SERVICES, INC. | 2850 W GOLF RD ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $709 | $709 | 1.12% |
| GALLAGHER BENEFIT SERVICES, INC. | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | $759 | — | $759 | 6.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACTIVE & FIT AMERICAN SPECIALTY HEA EIN 33-0883241 | Other services; Contract Administrator; Direct payment from the plan; Claims processing; Named fiduciary; Float revenue; Participant communication; Non-monetary compensation Service code 12 | 10221 WATERRIDGE CIRCLE SAN DIEGO, CA 92121 | $0 |
| AMPLIFON HEARING HEALTHCARE EIN 85-0437037 | Claims processing; Contract Administrator; Float revenue; Participant communication; Named fiduciary; Non-monetary compensation; Direct payment from the plan; Foreign entity (e.g., an agent or broker, bank, insurance company, etc. not operating within jurisdictional boundaries of the United States) Service code 12 | FIFTH STREET TOWERS 150 SOUTH 5TH ST SUITE 2300 MINNEAPOLIS, MN 55402 | $0 |
| CIGNA HEALTH & LIFE NSURANCE COMPA | Claims processing; Contract Administrator; Float revenue; Non-monetary compensation; Named fiduciary; Participant communication; Direct payment from the plan; Other services Service code 12 | — | $0 |
| FITBIT EIN 20-8920744 | Contract Administrator; Non-monetary compensation; Participant communication; Float revenue; Named fiduciary; Other services; Claims processing; Direct payment from the plan Service code 12 | 199 FREMONT ST SAN FRANCISCO, CA 94105 | $0 |
| LASIK-LCA-VISION INC. EIN 11-2882328 | Other services; Float revenue; Named fiduciary; Non-monetary compensation; Direct payment from the plan; Claims processing; Participant communication; Contract Administrator Service code 12 | 7840 MONTGOMERY ROAD CINCINNATI, OH 45236 | $0 |
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 | 290 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 290 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH & LIFE INSURANCE COMPANY | 112 | $585K |
| Vision | VISION SERVICE PLAN | 85 | $11K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 290 | $63K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 290 | $63K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 290 | $63K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 290 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.