| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC. Filed as: WELLS FARGO INS SERV USA INC (TX) | PO BOX 201469 DALLAS, TX 75320 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | — | — | $0 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERV USA INC (TX) | PO BOX 201469 DALLAS, TX 75320 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $33K | — | $33K | 15.26% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: WELLS FARGO INS SERVICES USA | 600 HIGHWAY 169 SOUTH STE 1200 ST LOUIS PARK, MN 55426 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $15K | $7K | $21K | 17.58% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC - HOU | PO BOX 201469 DALLAS, TX 753201469 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $13K | — | $13K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC - HOU | PO BOX 201469 DALLAS, TX 75320 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC - HOU | PO BOX 201469 DALLAS, TX 753201469 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 15.00% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | PO BOX 983 HOUSTON, TX 77001 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 9.36% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC - HOU | PO BOX 201469 DALLAS, TX 753201469 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA BEHAVIORAL HEALTH INC EIN 41-1648670 ADMINISTER EAP PLAN | Direct payment from the plan; Contract Administrator; Participant communication; Claims processing Service code 12 | 11095 VIKING DRIVE STE 300 EDEN PRARIE, MN 55344 | $611K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 ADMIN SVCS AGREEMENT | Participant communication; Other services; Claims processing; Contract Administrator; Float revenue; Non-monetary compensation; Named fiduciary; Direct payment from the plan Service code 12 | — | $162K |
| CIGNA BEHAVIORAL HEALTH, INC | Participant communication; Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $0 |
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 | 198 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 199 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 261 | $286K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 158 | $121K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 231 | $95K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 41 | $16K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 231 | $85K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 294 | $217K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 231 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 294 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.