| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL, 14TH FL ITASCA, IL 60143 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $9K | — | $9K | 0.92% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICE | PO BOX 203510, NC LOCKBOX DALLAS, TX 75320 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $9K | — | $9K | 0.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL ITASCA, IL 60143 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $5K | $13K | 2.37% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICE | PO BOX 203510, NC LOCKBOX DALLAS, TX 75320 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | — | $8K | 1.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL, 14TH FL ITASCA, IL 60143 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 1.50% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICE | PO BOX 203510, NC LOCKBOX DALLAS, TX 75320 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 1.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL ITASCA, IL 60143 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $2K | $4K | 2.47% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICE | PO BOX 203510, NC LOCKBOX DALLAS, TX 75320 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 1.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL, 14TH FL ITASCA, IL 60143 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $316 | — | $316 | 1.50% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICE | PO BOX 203510, NC LOCKBOX DALLAS, TX 75320 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $316 | — | $316 | 1.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL ITASCA, IL 60143 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $186 | $106 | $292 | 2.35% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICE | PO BOX 203510, NC LOCKBOX DALLAS, TX 75320 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $186 | — | $186 | 1.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL ITASCA, IL 60143 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $146 | $85 | $231 | 2.37% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICE | PO BOX 203510, NC LOCKBOX DALLAS, TX 75320 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $146 | — | $146 | 1.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL ITASCA, IL 60143 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $21 | $8 | $29 | 2.03% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICE | PO BOX 203510, NC LOCKBOX DALLAS, TX 75320 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $22 | — | $22 | 1.54% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CONTRACT ADMINISTOR | Participant communication; Float revenue; Claims processing; Non-monetary compensation; Named fiduciary; Other services; Contract Administrator; Direct payment from the plan Service code 12 | — | $873K |
| NATIVE AMERICAN INSURANCE SERVICES EIN 26-0004545 NONE | Contract Administrator Service code 13 | 508 BRIARBROOK DRIVE EAST PEORIA, IL 616114439 | $388K |
| THOMPSON, GREENSPON & CO., P.C. EIN 54-1029635 NONE | Accounting (including auditing) Service code 10 | 4035 RIDGE TOP ROAD, SUITE 700 FAIRFAX, VA 22030 | $7K |
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 | 1,298 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 22 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,336 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TRIPLE S SALUD, INC. | 16 | $95K |
| Dental | TRIPLE S SALUD, INC. | 16 | $63K |
| Vision | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 2,345 | $115K |
| Life insurance(2 contracts) | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,232 | $235K |
| Long-term disability | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,232 | $163K |
| Prescription drug | TRIPLE S SALUD, INC. | 16 | $63K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 2,232 | $931K |
| Other(7 contracts, 3 carriers) | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,232 | $870K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,345 | — |
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.