| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 1847 W JEFFERSON AVE NAPERVILLE, IL 60540 | CONNECTICUT HEALTH AND LIFE INSURANCE COMPANY | $338K | — | $338K | 6.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 1847 W JEFFERSON AVE NAPERVILLE, IL 60540 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $2K | $10K | 7.56% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 1847 WEST JEFFERSON AVE NAPERVILLE, IL 60540 | COMPANION LIFE INSURANCE | $9K | — | $9K | 9.43% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 1847 W JEFFERSON AVE NAPERVILLE, IL 60540 | COMPBENEFITS | $8K | — | $8K | 9.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC. EIN 35-1450364 NONE | Claims processing Service code 12 | 8330 ALLISION POINT TRAIL INDIANAPOLIS, IN 46250 | $81K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMINISTRATOR | Direct payment from the plan; Contract Administrator; Claims processing; Named fiduciary; Float revenue; Non-monetary compensation; Other services; Participant communication Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $38K |
| GALLAGHER BENEFIT SERVICES, INC. EIN 36-4291971 NONE | Consulting (general) Service code 16 | 1847 WEST JEFFERSON AVE. NAPERVILLE, IL 60540 | $26K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 8330 ALLISON POINT TRAIL INDIANAPOLIS, IN 46250 | $17K |
| MULTIPLAN EIN 35-2048379 NONE | Plan Administrator Service code 14 | 115 5TH AVENUE, 7TH FLOOR NEW YORK, NY 10003 | $6K |
| RGI, LLC EIN 32-0176370 NONE | Insurance services Service code 23 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | $6K |
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 | 1,957 | 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) | 1,957 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CONNECTICUT HEALTH AND LIFE INSURANCE COMPANY | 923 | $5.6M |
| Dental | CONNECTICUT HEALTH AND LIFE INSURANCE COMPANY | 923 | $5.5M |
| Vision | COMPBENEFITS | 645 | $77K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 710 | $126K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,957 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,957 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.