| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROFESSIONAL GROUP MARKETING INC3 | 420 LEXINGTON AVE SUITE 638 NEW YORK, NY 10170 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | -$415 | -$415 | -0.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERV USA, INC (NJ) | PO BOX 203066 DALLAS, TX 753203066 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $5K | $0 | $5K | 5.35% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC NY | 2 PIERCE PL ITASCA, IL 60143 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $1K | $0 | $1K | 1.09% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SER | PO BOX 823237 PENNSYLVANIA LOCKBOX PHILADELPHIA, PA 19182 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $3K | $871 | $4K | 14.16% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL 14TH FL ITASCA, IL 60143 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $134 | $0 | $134 | 0.45% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SER | PO BOX 823237 PENNSYLVANIA LOCKBOX PHILADELPHIA, PA 19182 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $2K | $514 | $2K | 11.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL 14TH FL ITASCA, IL 60143 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $162 | $0 | $162 | 0.90% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SER | PO BOX 823237 PENNSYLVANIA LOCKBOX PHILADELPHIA, PA 19182 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $149 | $47 | $196 | 11.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL 14TH FL ITASCA, IL 60143 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $15 | $0 | $15 | 0.91% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 NONE | Claims processing; Contract Administrator Service code 12 | — | $97K |
| WELLS FARGO INS SERV USA, INC (NJ) NONE | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | PO BOX 203066 DALLAS, TX 753203066 | $45K |
| GALLAGHER BENEFIT SERVICES, INC NY NONE | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 2 PIERCE PL ITASCA, IL 60143 | $9K |
| ASHTON BENEFITS NONE | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 600 SYLVAN AVE ENGLEWOOD CLIFFS, NJ 07632 | -$933 |
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 | 193 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 196 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 216 | $516K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 124 | $97K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 124 | $97K |
| Life insurance | CIGNA LIFE INSURANCE CO. OF NEW YORK | 193 | $18K |
| Long-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 47 | $30K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 216 | $516K |
| Other(2 contracts) | CIGNA LIFE INSURANCE CO. OF NEW YORK | 193 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 216 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.