| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD SUITE 1600 ROLLING MEADOWS, IL 60009 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $11K | $35K | $46K | 3.24% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | P.O. BOX 896620 CHARLOTTE, NC 28289 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $4K | $10K | $13K | 0.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 1900 WEST LOOP S SUITE 1600 HOUSTON, TX 77027 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | $825 | $8K | 9.42% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES INC. | 5080 SPECTRUM DRIVE SUITE 900E ADDISON, TX 75001 | PRINCIPAL LIFE INSURANCE COMPANY | $916 | — | $916 | 1.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF ROAD FL 11 ROLLING MEADOWS, IL 60008 | PRINCIPAL LIFE INSURANCE COMPANY | — | $346 | $346 | 0.41% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS. CO. EIN 59-1031071 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $40K |
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 | 176 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 178 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 220 | $1.4M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 220 | $1.4M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 220 | $1.4M |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 165 | $84K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 165 | $84K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 165 | $84K |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 165 | $84K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 220 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.