| 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 | $197K | — | $197K | 14.08% |
| LOUIS A DECHIARA3 | 875 3RD AVENUE 23RD FLOOR NEW YORK, NY 10022 | FIRST UNUM LIFE INSURANCE COMPANY | $33K | — | $33K | 6.35% |
| DAVID J HACHEY3 | 5 GATE HOUSE LANE MAMARONECK, NY 10543 | FIRST UNUM LIFE INSURANCE COMPANY | $29K | — | $29K | 5.60% |
| PHILIP T DAVIS3 | PO BOX 8865 NEW FAIRFIELD, CT 06812 | FIRST UNUM LIFE INSURANCE COMPANY | $29K | — | $29K | 5.60% |
| CHRISTINA E LAWRENCE3 | 37 EAST 1ST STREET 1W NEW YORK, NY 10003 | FIRST UNUM LIFE INSURANCE COMPANY | $6K | — | $6K | 1.12% |
| MARSH & MCLENNAN AGENCY LLC3 | PARK 80 WEST PLAZA TWO 250 PEHLE AVENUE 400 SADDLEBROOK, NJ 07663 | FIRST UNUM LIFE INSURANCE COMPANY | $9K | — | $9K | 3.92% |
| FIDUCIARY INTERMEDIARY LTD0 | 370 LEXINGTON AVENUE RM 703 NEW YORK, NY 10017 | FIRST UNUM LIFE INSURANCE COMPANY | — | $3K | $3K | 1.31% |
| MARSH & MCLENNAN AGENCY LLC3 | PARK 80 WEST PLAZA TWO 250 PEHLE AVENUE 400 SADDLEBROOK, NJ 07663 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | — | $2K | 0.93% |
| MARSH & MCLENNAN AGENCY LLC | PARK 80 WEST PLAZA TWO 250 PEHLE AVENUE 400 SADDLEBROOK, NJ 07663 | CIGNA HEALTH & LIFE INSURANCE COMPANY | $16K | — | $16K | 10.03% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | NEW YORK LIFE GROUP BENEFIT SOLUTIONS | $4K | $2K | $6K | 5.53% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | NEW YORK LIFE GROUP BENEFIT SOLUTIONS | $2K | $126 | $2K | 14.62% |
| LOUIS A DECHIARA3 | 875 3RD AVENUE 23RD FLOOR NEW YORK, NY 10022 | FIRST UNUM LIFE INSURANCE COMPANY | $759 | — | $759 | 6.80% |
| DAVID J HACHEY3 | 5 GATE HOUSE LANE MAMARONECK, NY 10543 | FIRST UNUM LIFE INSURANCE COMPANY | $670 | — | $670 | 6.00% |
| PHILIP T DAVIS3 | PO BOX 8865 NEW FAIRFIELD, CT 06812 | FIRST UNUM LIFE INSURANCE COMPANY | $670 | — | $670 | 6.00% |
| CHRISTINA E LAWRENCE3 | 37 EAST 1ST STREET 1W NEW YORK, NY 10003 | FIRST UNUM LIFE INSURANCE COMPANY | $134 | — | $134 | 1.20% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EVERNORTH BEHAVIORAL HEALTH INC. EIN 41-1648670 CONTRACTED WITH EMPLOYER | Claims processing; Direct payment from the plan; Contract Administrator; Participant communication Service code 12 | CITIBANK NA ONE PENNS WAY NEW CASTLE, DE 19720 | $9K |
| CIGNA HEALTH & LIFE INSURANCE COMPA EIN 59-1031071 MEDICAL FEES | Participant communication; Other services; Claims processing; Contract Administrator; Float revenue; Non-monetary compensation; Named fiduciary; Direct payment from the plan Service code 12 | 900 COTTAGE GROVE ROAD C8NAS HARTFORD, CT 06152 | $926 |
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 | 620 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 620 | 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 | 620 | $1.6M |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 620 | $1.6M |
| Vision | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 620 | $1.4M |
| Life insurance | NEW YORK LIFE GROUP BENEFIT SOLUTIONS | 357 | $101K |
| Short-term disability(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 392 | $398K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 356 | $222K |
| Prescription drug | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 620 | $1.4M |
| Other(5 contracts, 4 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES | 620 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 620 | — |
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.