| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 250 PARK AVENUE 3RD FLOOR NEW YORK, NY 10177 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | — | — | $0 | 0.00% |
| HOWARTH III, FREDERICK W3 | 6077 BRISTOL PARKWAY CULVER CITY, CA 90230 | FIRST UNUM LIFE INSURANCE COMPANY | $39K | $16K | $54K | 7.00% |
| HOWARTH III, FREDERICK W3 | 6077 BRISTOL PARKWAY CULVER CITY, CA 90230 | FIRST UNUM LIFE INSURANCE COMPANY | $21K | $8K | $30K | 7.00% |
| HOWARTH III, FREDERICK W3 | 6077 BRISTOL PARKWAY CULVER CITY, CA 90230 | FIRST UNUM LIFE INSURANCE COMPANY | $9K | $2K | $11K | 12.62% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 ASO SERVICE PROVIDER | 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 ROAD HARTFORD, CT 06152 | $42 |
| CIGNA 59-1031071 | Contract Administrator; Direct payment from the plan; Named fiduciary; Non-monetary compensation; Claims processing; Float revenue; Participant communication; Other services Service code 12 | — | $0 |
| CIGNA 59-1031971 | Participant communication; Non-monetary compensation; Other services; Claims processing; Direct payment from the plan; Contract Administrator; Named fiduciary; Float revenue 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 | 806 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 64 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,707 | $2.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,707 | $2.0M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,707 | $2.0M |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 720 | $425K |
| Short-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 528 | $87K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 819 | $777K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,707 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,707 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.