| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BOLLINGER INC3 | 200 JEFFERSON PARK WHIPPANY, NJ 07981 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $8K | — | $8K | 0.81% |
| BOLLINGER INC3 | 200 JEFFERSON PARK WHIPPANY, NJ 07981 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $7K | — | $7K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $609 | $609 | 0.83% |
| BOLLINGER INC3 | 200 JEFFERSON PARK WHIPPANY, NJ 07981 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 11.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 INSURANCE PROVIDER | 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 061527314 | $444K |
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 | 561 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 561 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 873 | $924K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 561 | $74K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 133 | $33K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 873 | $924K |
| Other | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 561 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 873 | — |
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.