| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BRIAN M LIBBY | 88 WEBB COVE DRIVE LOWELL, ME 044930000 | CIGNA HEALTH & LIFE INSURANCE COMPANY | $9K | — | $9K | 1.56% |
| LIBBY, BRIAN, MAURICE | 88 WEBB COVE DRIVE LOWELL, ME 04493 | AMERITAS LIFE INSURANCE CORP. | $3K | — | $3K | 3.76% |
| BRIAN M LIBBY | 88 WEBB COVE DRIVE LOWELL, ME 044930000 | CIGNA HEALTH & LIFE INSURANCE COMPANY | $227 | — | $227 | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO. EIN 59-1031071 ADMINISTRATOR | Named fiduciary; Claims processing; Non-monetary compensation; Direct payment from the plan; Float revenue; Insurance services; Other services; Participant communication; Contract Administrator Service code 12 | 8505 E ORCHARD ROAD GREENWOOD VILLAGE, CO 80111 | $5K |
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 | 119 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 119 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH & LIFE INSURANCE COMPANY | 119 | $582K |
| Dental | AMERITAS LIFE INSURANCE CORP. | 191 | $78K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 191 | $78K |
| Life insurance | CIGNA HEALTH & LIFE INSURANCE COMPANY | 119 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 191 | — |
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.