| 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 | 0.96% |
| BOLLINGER INC3 | 200 JEFFERSON PARK WHIPPANY, NJ 07981 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | $1K | $9K | 10.60% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | NORTHEAST 3RD FLOOR 250 PARK AVENUE NEW YORK, NY 10177 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 16.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 400 MIDLAND DRIVE SUITE 300 MT LAUREL, NJ 08054 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $536 | — | $536 | 1.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 INSURANCE PROVIDER | Participant communication; Float revenue; Other services; Named fiduciary; Direct payment from the plan; Contract Administrator; Non-monetary compensation; Claims processing Service code 12 | 900 COTTAGE GROVE ROAD HARTFORD, CT 061527314 | $585K |
| BOLLINGER INC EIN 36-2481781 | Insurance agents and brokers Service code 22 | 200 JEFFERSON PARK WHIPPANY, NJ 07981 | $108K |
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 | 708 | 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) | 708 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 881 | $834K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 708 | $84K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 109 | $19K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 83 | $32K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 881 | $834K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 708 | $84K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 881 | — |
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.