| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $14K | $157K | $171K | 4.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 21ST FLOOR ITASCA, IL 60143 | FIRST UNUM LIFE INSURANCE COMPANY | $9K | $0 | $9K | 4.74% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.23% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 1 JERICHO PLAZA, SUITE 200 JERICHO, NY 11753 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | HM LIFE INSURANCE COMPANY OF NEW YORK | $2K | $0 | $2K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 100 MATSONFORD ROAD, SUITE 100 RADNOR, PA 19087 | FEDERAL INSURANCE COMPANY | $2K | $67 | $2K | 15.55% |
| GALLAGHER BENEFIT SERVICES, INC.4 | 100 MERIDIAN CENTRE BOULEVARD SUITE 100 ROCHESTER, NY 14618 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | $0 | $1K | 16.44% |
| CALLETA PARTNERS LLC4 | 11775 CALLETA COURT PALM BEACH GARDENS, FL 33418 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $155 | $0 | $155 | 1.99% |
No Schedule C service providers reported on this filing.
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 | 164 | 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) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 164 | $4.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 164 | $4.1M |
| Vision | HM LIFE INSURANCE COMPANY OF NEW YORK | 151 | $19K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 150 | $182K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 150 | $182K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 164 | $4.1M |
| Other(3 contracts, 3 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 164 | $202K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 164 | — |
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.