| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 SOUTH 8TH STREET STE 700 MINNEAPOLIS, MN 55402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 2.40% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 141 W JACKSON BLVD SUITE 1000 CHICAGO, IL 60605 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$107 | — | -$107 | -0.22% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 141 W JACKSON BLVD SUITE 1000 CHICAGO, IL 60605 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $817 | — | $817 | 1.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 141 W JACKSON BLVD STE 1000 CHICAGO, IL 60605 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $437 | — | $437 | 14.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 6967 SO RIVER GATE DR STE 200 SALT LAKE CITY, UT 84047 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $157 | — | $157 | 14.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 6967 SO RIVER GATE DR STE 200 SALT LAKE CITY, UT 84047 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $115 | — | $115 | 14.94% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 6967 SO RIVER GATE DR STE 200 SALT LAKE CITY, UT 84047 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $71 | — | $71 | 14.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 ADMINISTRATOR | Contract Administrator Service code 13 | — | $52K |
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 | 166 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 166 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 137 | $789K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 137 | $789K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 137 | $789K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 166 | $31K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 65 | $48K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 66 | $45K |
| Other(4 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 68 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 166 | — |
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.
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.