| 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) | $293K | — | $293K | 35.87% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | TWO PIERCE PLACE ITASCA, IL 60143 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $18K | $2K | $20K | 13.69% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | TWO PIERCE PLACE ITASCA, IL 60143 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $15K | $2K | $16K | 13.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | TWO PIERCE PLACE ITASCA, IL 60143 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $10K | $1K | $11K | 13.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIM ADMINISTRATION | Non-monetary compensation; Contract Administrator; Named fiduciary; Other services; Direct payment from the plan; Claims processing; Float revenue; Participant communication Service code 12 | 900 COTTAGE GROVE ROAD HARTFORD, CT 06152 | $1.1M |
| CIGNA | Non-monetary compensation; Named fiduciary; Float revenue; Claims processing; Participant communication; Other services; Direct payment from the plan; Contract Administrator Service code 12 | — | $962 |
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 | 672 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 685 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,762 | $816K |
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 672 | $144K |
| Short-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 727 | $118K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 726 | $78K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,762 | $816K |
| Other | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,762 | $816K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,762 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.