| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BOLLINGER INC3 | 200 JEFFERSON PARK WHIPPANY, NJ 07981 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 8.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 10.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF RD 4TH FL ROLLING MEADOWS, IL 60008 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 INSURANCE PROVIDER | Named fiduciary; Other services; Non-monetary compensation; Participant communication; Claims processing; Float revenue; Contract Administrator; Direct payment from the plan Service code 12 | 900 COTTAGE GROVE ROAD HARTFORD, CT 061527314 | $683K |
| BOLLINGER INC EIN 36-2481781 | Insurance agents and brokers Service code 22 | 200 JEFFERSON PARK WHIPPANY, NJ 07981 | $113K |
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 | 596 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 596 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 862 | $815K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 596 | $73K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 142 | $38K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 862 | $815K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 862 | $815K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 596 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 862 | — |
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.