| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 11060 WHITE ROCK RD, STE 160 RANCHO CORDOVA, CA 95670 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $3K | $975 | $4K | 3.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2850 WEST GOLF RD 5TH FLOOR ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $551 | $3K | 10.11% |
| GCG FINANCIAL LLC3 | 3 PKWY N 500 DEERFIELD, IL 60015 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $516 | — | $516 | 1.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2850 WEST GOLF RD 5TH FLOOR ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $366 | $2K | 10.17% |
| GCG FINANCIAL LLC3 | 3 PKWY N 500 DEERFIELD, IL 60015 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $331 | — | $331 | 1.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2850 WEST GOLF RD 5TH FLOOR ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $335 | $2K | 10.23% |
| GCG FINANCIAL LLC3 | 3 PKWY N 500 DEERFIELD, IL 60015 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $296 | — | $296 | 1.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2850 WEST GOLF RD 5TH FLOOR ROLLING MEADOWS, IL 60008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $354 | $76 | $430 | 10.12% |
| GCG FINANCIAL LLC3 | 3 PKWY N 500 DEERFIELD, IL 60015 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $70 | — | $70 | 1.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 THIRD PARTY ADMINISTRATO | Direct payment from the plan; Named fiduciary; Participant communication; Other services; Claims processing; Non-monetary compensation; Contract Administrator; Float revenue Service code 12 | — | $78K |
| GALLAGHER BENEFIT SERVICES BROKER | Insurance agents and brokers Service code 22 | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | $71K |
| INFINISOURCE THIRD PARTY ADMINISTRATO | Claims processing; Contract Administrator Service code 12 | 15 E WASHINGTON ST #100 COLDWATER, MI 49036 | $6K |
| CIGNA | Float revenue; Non-monetary compensation; Direct payment from the plan; Named fiduciary; Participant communication; Contract Administrator; Other services; Claims processing Service code 12 | — | $0 |
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 | 212 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 17 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 229 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 204 | $96K |
| Vision | VISION SERVICE PLAN | 161 | $15K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 212 | $20K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 212 | $31K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 93 | $18K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 252 | $377K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 221 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 252 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.