| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| 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 | 1.01% |
| 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 | 1.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 2 PIERCE PL ITASCA, IL 60143 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $8K | $17K | 2.99% |
| 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 ITASCA, IL 60143 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $2K | $6K | 2.68% |
| 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, 14TH FL ITASCA, IL 60143 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $3K | $6K | 3.15% |
| 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, 14TH FL ITASCA, IL 60143 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $306 | $317 | $623 | 3.05% |
| 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 | $306 | — | $306 | 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 | $165 | $174 | $339 | 3.09% |
| 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 | $165 | — | $165 | 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 | $162 | $150 | $312 | 2.89% |
| 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 | $162 | — | $162 | 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 | $14 | $22 | $36 | 3.75% |
| 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 | $15 | — | $15 | 1.56% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CONTRACT ADMINISTOR | Named fiduciary; Other services; Claims processing; Direct payment from the plan; Non-monetary compensation; Participant communication; Float revenue; Contract Administrator Service code 12 | — | $890K |
| NATIVE AMERICAN INSURANCE SERVICES EIN 26-0004545 NONE | Contract Administrator Service code 13 | 102 SUPREME COURT EAST PEORIA, IL 616111442 | $375K |
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 | 1,322 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 22 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,344 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TRIPLE S SALUD, INC. | 18 | $95K |
| Dental | TRIPLE S SALUD, INC. | 18 | $72K |
| Vision | VISION SERVICE PLAN | 1,174 | $118K |
| Life insurance(2 contracts) | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,979 | $215K |
| Long-term disability | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,979 | $208K |
| Prescription drug | TRIPLE S SALUD, INC. | 18 | $72K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,979 | $881K |
| Other(7 contracts, 3 carriers) | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,979 | $870K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,979 | — |
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."
No prospect flags tripped on this filing.