| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD 11TH FLOOR ROLLING MEADOWS, IL 60008 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $7K | $7K | 1.20% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 1 JERICHO PLZ STE 200 JERICHO, NY 11753 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD STE 1000 ROLLING MDWS, IL 600084036 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $8K | $8K | 2.83% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD 11TH FLOOR ROLLING MEADOWS, IL 60008 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $2K | $2K | 0.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 1 JERICHO PLZ STE 200 JERICHO, NY 11753 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| THE FARMINGTON COMPANY3 | 30 WATERSIDE DR PO BOX 527 FARMINGTON, CT 06034 | FIRST UNUM LIFE INSURANCE COMPANY | $15K | $1K | $16K | 10.99% |
| THE FARMINGTON COMPANY3 | 30 WATERSIDE DR PO BOX 527 FARMINGTON, CT 06034 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $28 | $0 | $28 | 4.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 NONE | Participant communication; Contract Administrator; Float revenue; Other services; Claims processing; Direct payment from the plan; Named fiduciary; Non-monetary compensation Service code 12 | — | $2.0M |
| GALLAGHER BENEFIT SERVICES, INC NONE | Insurance agents and brokers; Consulting fees Service code 22 | 2850 GOLF RD STE 1000 ROLLING MEADOWS, IL 60008 | $86K |
| J5 CONSULTING NONE | Consulting fees; Insurance agents and brokers Service code 22 | 166 WEST PUTNAM AVENUE GREENWICH, CT 06830 | $86K |
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 | 4,104 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 110 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,224 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 4,272 | $2.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 4,272 | $2.1M |
| Life insurance(3 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 4,104 | $882K |
| Short-term disability(2 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 477 | $147K |
| Long-term disability | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 3,575 | $299K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 4,272 | $2.1M |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 4,272 | $2.1M |
| Other(5 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 4,272 | $2.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,272 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.