| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $45K | $45K | 3.00% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC. | $7K | — | $7K | 7.23% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $734 | $3K | 14.02% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $604 | $3K | 19.00% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | EYEMED VISION CARE | $1K | — | $1K | 8.53% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET CONNECTOR PARK LOWELL, MA 01851 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $708 | $290 | $998 | 14.09% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 SERVICE PROVIDER | Claims processing Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $54K |
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 | 165 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 204 | $1.5M |
| Dental | ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC. | 229 | $92K |
| Vision | EYEMED VISION CARE | 162 | $13K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 165 | $7K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 165 | $18K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 165 | $15K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 165 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 229 | — |
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.