| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DONALD C SAVOY INC3 Filed as: DONALD C. SAVOY INC | ROUND TABLE STUDIOS 200 CONNELL DR #1000 BERKELEY HEIGHTS, NJ 07922 | CIGNA HEALTH & LIFE INSURANCE COMPANY | — | $100K | $100K | 1.50% |
| OTTERSTEDT INS AGENCY INC3 Filed as: OTTERSTEDT INSURANCE AGENCY | 540 SYLVAN AVENUE ENGLEWOOD CLIFFS, NJ 07632 | CIGNA HEALTH & LIFE INSURANCE COMPANY | — | $83K | $83K | 1.25% |
| DONALD C SAVOY INC3 Filed as: DONALD C. SAVOY INC | 445 BROADHOLLOW RD SUITE 119 MELVILLE, NY 11747 | GUARDIAN | $89K | $17K | $106K | 12.09% |
| BOON ADMINISTRATIVE SERVICES3 Filed as: BOON ADMINISTRATIVE SERVICES INC, | 234 SPRING LAKE DRIVE ITASCA, IL 60143 | METROPOLITAN GENERAL INSURANCE COMPANY | — | $27K | $27K | 31.99% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS | PO BOX 310502 DES MOINES, IA 503310502 | METROPOLITAN GENERAL INSURANCE COMPANY | $8K | — | $8K | 10.00% |
| DONALD C SAVOY INC3 Filed as: DONALD C SAVOY INC DBA SAVOY ASSOC | 25B HANOVER RD SUITE 220 FLORHAM PARK, NC 07932 | METROPOLITAN GENERAL INSURANCE COMPANY | — | $3K | $3K | 3.78% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 900 COTTAGE GROVE RD BLOOMFIELD, CA 06002 | $105K |
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 | 517 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 524 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH & LIFE INSURANCE COMPANY | 644 | $6.7M |
| Dental | GUARDIAN | 517 | $879K |
| Vision | GUARDIAN | 517 | $879K |
| Life insurance | GUARDIAN | 517 | $879K |
| Short-term disability | GUARDIAN | 517 | $879K |
| Long-term disability | GUARDIAN | 517 | $879K |
| Other(2 contracts, 2 carriers) | GUARDIAN | 517 | $962K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 644 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.