| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | ONE JERICO PLAZA, SUITE 200 JERICO, NY 11753 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $45K | $1K | $46K | 5.84% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS | 422 WAUPONSEE STREET MORRIS, IL 60450 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $5K | $4K | $10K | 9.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN INC. | 9401 AMBERGLEN BOULEVARD BUILDING 1, SUITE 100 AUSTIN, TX 78729 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $5K | $0 | $5K | 4.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $4K | $0 | $4K | 4.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $0 | $1K | $1K | 1.13% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 114 | $796K |
| Dental | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | 98 | $106K |
| Vision | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | 98 | $106K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 114 | $796K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 114 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.