| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 | 330 MADISON AVE 7TH FLOOR NEW YORK, NY 10017 | AETNA LIFE INSURANCE COMPANY | $19K | — | $19K | 2.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 250 PARK AVE, 3RD FL NEW YORK, NY 10177 | AETNA LIFE INSURANCE COMPANY | $6K | — | $6K | 0.63% |
| WELLS FARGO INSURANCE SERVICES3 | 1445 ROSS AVE, STE 100 DALLAS, TX 75202 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $8K | — | $8K | 0.99% |
| WELLS FARGO INSURANCE SERVICES3 | 123 S. BROAD ST. PHILADELPHIA, PA 19109 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $4K | — | $4K | 0.51% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $4K | — | $4K | 0.51% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CONTRACT ADMINISTOR | Contract Administrator; Direct payment from the plan; Other services; Participant communication; Non-monetary compensation; Claims processing; Named fiduciary; Float revenue Service code 12 | 280 TRUMBULL ST. 5 HARTFORD, CT 06103 | $761K |
| NATIVE AMERICAN INSURANCE SERVICES EIN 26-0004545 NONE | Contract Administrator Service code 13 | 102 SUPREME COURT EAST PEORIA, IL 616111442 | $376K |
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 | 1,285 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,293 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TRIPLE S SALUD, INC. | 18 | $90K |
| Vision | VISION SERVICE PLAN | 1,118 | $110K |
| Life insurance | AETNA LIFE INSURANCE COMPANY | 1,609 | $904K |
| Short-term disability | AETNA LIFE INSURANCE COMPANY | 1,609 | $904K |
| Long-term disability | AETNA LIFE INSURANCE COMPANY | 1,609 | $904K |
| Prescription drug | TRIPLE S SALUD, INC. | 18 | $77K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,775 | $766K |
| Other(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 1,609 | $982K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,775 | — |
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.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.