| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 | PARK 80 WEST PLAZA TWO 250 PEHLE AVENUE 400 SADDLEBROOK, NJ 07663 | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | $138K | $2K | $140K | 15.30% |
| LOUIS A DECHIARA3 | 875 3RD AVENUE 23RD FLOOR NEW YORK, NY 10022 | FIRST UNUM LIFE INSURANCE COMPANY | $40K | — | $40K | 7.39% |
| DAVID J HACHEY3 | 245 PARK AVENUE 18TH FLOOR NEW YORK, NY 10167 | FIRST UNUM LIFE INSURANCE COMPANY | $35K | — | $35K | 6.52% |
| PHILIP T DAVIS3 | PO BOX 8865 NEW FAIRFIELD, CT 06812 | FIRST UNUM LIFE INSURANCE COMPANY | $35K | — | $35K | 6.52% |
| CHRISTINA E LAWRENCE3 | 37 EAST 1ST STREET 1W NEW YORK, NY 10003 | FIRST UNUM LIFE INSURANCE COMPANY | $7K | — | $7K | 1.30% |
| MARSH & MCLENNAN AGENCY LLC3 | PARK 80 WEST PLAZA TWO 250 PEHLE AVENUE 400 SADDLEBROOK, NJ 07663 | FIRST UNUM LIFE INSURANCE COMPANY | $9K | — | $9K | 4.93% |
| MARSH & MCLENNAN AGENCY LLC3 | PARK 80 WEST PLAZA TWO 250 PEHLE AVENUE 400 SADDLEBROOK, NJ 07663 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $3K | — | $3K | 7.05% |
| MARSH & MCLENNAN AGENCY LLC3 | PARK 80 WEST PLAZA TWO 250 PEHLE AVENUE 400 SADDLEBROOK, NJ 07663 | FIRST UNUM LIFE INSURANCE COMPANY | $1K | — | $1K | 3.96% |
| MARSH & MCLENNAN AGENCY LLC3 | PARK 80 WEST PLAZA TWO 250 PEHLE AVENUE 400 SADDLEBROOK, NJ 07663 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $986 | — | $986 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA BEHAVIORAL HEALTH INC. EIN 41-1648670 CONTRACTED WITH EMPLOYER | Direct payment from the plan; Participant communication; Contract Administrator; Claims processing Service code 12 | CITIBANK NA ONE PENNS WAY NEW CASTLE, DE 19720 | $7K |
| CIGNA HEALTH & LIFE INSURANCE COMPA EIN 59-1031071 CLAIM ADMINISTRATION | Contract Administrator; Direct payment from the plan; Named fiduciary; Non-monetary compensation; Claims processing; Float revenue; Participant communication; Other services Service code 12 | 900 COTTAGE GROVE ROAD C8NAS HARTFORD, CT 06152 | $736 |
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 | 383 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 383 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 579 | $915K |
| Dental | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 579 | $915K |
| Vision | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 579 | $915K |
| Life insurance | CIGNA LIFE INSURANCE CO. OF NEW YORK | 0 | $49K |
| Short-term disability(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 383 | $211K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 356 | $177K |
| Prescription drug | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 579 | $915K |
| Other(3 contracts, 3 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 579 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 579 | — |
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.