| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHRISTINE M. MCCULLUGH3 Filed as: CHRISTINE M. MC CULLUGH | 14715 NE 95TH STREET, SUITE 200 REDMOND, WA 98052 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $29K | $0 | $29K | 15.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $82 | $82 | 0.63% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 200 BERKLY STREET, 23RD FLOOR BOSTON, MA 02116 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $65 | $65 | 0.50% |
No Schedule C service providers reported on this filing.
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,797 | $1.3M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY LIFE INSURANCE CO. | 619 | $124K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,279 | $1.1M |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 1,279 | $1.1M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,279 | $1.1M |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,797 | $1.3M |
| Other(4 contracts, 4 carriers) | HARTFORD LIFE AND ACCIDENT | 1,279 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,797 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.