| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | AETNA LIFE INSURANCE CO. | $10K | — | $10K | 0.47% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE INC. | 4000 MIDLANTIC AVENUE SUITE 300 MOUNT LAUREL, NJ 08054 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $536 | $4K | 5.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 4000 MIDLANTIC AVENUE SUITE 300 MOUNT LAUREL, NJ 08054 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $418 | $5K | 10.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE INC. | 4000 MIDLANTIC AVENUE SUITE 300 MOUNT LAUREL, NJ 08054 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $300 | $4K | 11.71% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | VISION SERVICE PLAN | $1K | — | $1K | 5.03% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE INC. | 4000 MIDLANTIC AVENUE SUITE 300 MOUNT LAUREL, NJ 08054 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $545 | $93 | $638 | 5.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GALLAGHER BENEFIT SERVICES INC. BROKER | Insurance agents and brokers Service code 22 | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | $106K |
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 | 329 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 330 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 493 | $2.2M |
| Dental | AETNA LIFE INSURANCE CO. | 493 | $2.2M |
| Vision | VISION SERVICE PLAN | 250 | $25K |
| Life insurance | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 515 | $67K |
| Short-term disability | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 113 | $47K |
| Long-term disability | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 434 | $34K |
| Other | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 471 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 515 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.