| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | TWO PIERCE PLACE ITASCA, IL 60143 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | $267K | — | $267K | 40.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | TWO PIERCE PLACE ITASCA, IL 60143 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $18K | $528 | $18K | 14.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | TWO PIERCE PLACE ITASCA, IL 60143 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $15K | $461 | $15K | 14.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | TWO PIERCE PLACE ITASCA, IL 60143 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $9K | $291 | $10K | 14.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CLAIM ADMIN | Named fiduciary; Direct payment from the plan; Contract Administrator; Other services; Participant communication; Float revenue; Non-monetary compensation; Claims processing Service code 12 | 900 COTTAGE GROVE ROAD HARTFORD, CT 06152 | $783K |
| CIGNA | Named fiduciary; Non-monetary compensation; Other services; Claims processing; Float revenue; Participant communication; Contract Administrator; Direct payment from the plan Service code 12 | — | $0 |
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 | 611 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 621 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,656 | $658K |
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 664 | $128K |
| Short-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 664 | $107K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 664 | $68K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,656 | $658K |
| Other | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,656 | $658K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,656 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.