| 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 | $154K | — | $154K | 14.06% |
| LOUIS A DECHIARA3 | 875 3RD AVENUE 23RD FLOOR NEW YORK, NY 10022 | FIRST UNUM LIFE INSURANCE COMPANY | $39K | — | $39K | 6.80% |
| DAVID J HACHEY3 | 5 GATE HOUSE LANE MAMARONECK, NY 10543 | FIRST UNUM LIFE INSURANCE COMPANY | $35K | — | $35K | 6.00% |
| PHILIP T DAVIS3 | PO BOX 8865 NEW FAIRFIELD, CT 06812 | FIRST UNUM LIFE INSURANCE COMPANY | $35K | — | $35K | 6.00% |
| CHRISTINA E LAWRENCE3 | 37 EAST 1ST STREET 1W NEW YORK, NY 10003 | FIRST UNUM LIFE INSURANCE COMPANY | $7K | — | $7K | 1.20% |
| MARSH & MCLENNAN AGENCY LLC3 | PARK 80 WEST PLAZA TWO 250 PEHLE AVENUE 400 SADDLEBROOK, NJ 07663 | FIRST UNUM LIFE INSURANCE COMPANY | $9K | — | $9K | 4.67% |
| FIDUCIARY INTERMEDIARY LTD0 | 370 LEXINGTON AVENUE RM 703 NEW YORK, NY 10017 | FIRST UNUM LIFE INSURANCE COMPANY | — | $3K | $3K | 1.31% |
| MARSH & MCLENNAN AGENCY LLC | PARK 80 WEST PLAZA TWO 250 PEHLE AVENUE 400 SADDLEBROOK, NJ 07663 | CIGNA HEALTH & LIFE INSURANCE COMPANY | $14K | — | $14K | 10.00% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $4K | $646 | $4K | 8.12% |
| MARSH & MCLENNAN AGENCY LLC3 | PARK 80 WEST PLAZA TWO 250 PEHLE AVENUE 400 SADDLEBROOK, NJ 07663 | FIRST UNUM LIFE INSURANCE COMPANY | $1K | — | $1K | 2.98% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $1K | $83 | $1K | 16.21% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA BEHAVIORAL HEALTH INC. EIN 41-1648670 CONTRACTED WITH EMPLOYER | Direct payment from the plan; Claims processing; Participant communication; Contract Administrator Service code 12 | CITIBANK NA ONE PENNS WAY NEW CASTLE, DE 19720 | $7K |
| CIGNA HEALTH & LIFE INSURANCE COMPA EIN 59-1031071 MEDICAL FEES | Non-monetary compensation; Other services; Direct payment from the plan; Contract Administrator; Claims processing; Named fiduciary; Participant communication; Float revenue Service code 12 | 900 COTTAGE GROVE ROAD C8NAS HARTFORD, CT 06152 | $824 |
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 | 660 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 660 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 660 | $1.2M |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 660 | $1.2M |
| Vision | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 660 | $1.1M |
| Life insurance | CIGNA LIFE INSURANCE CO. OF NEW YORK | 401 | $53K |
| Short-term disability(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 410 | $243K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 394 | $194K |
| Prescription drug | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 660 | $1.1M |
| Other(4 contracts, 4 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 660 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 660 | — |
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.