| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FLEISCHER JACOBS & ASSOCIATES INC3 | PO BOX 2343 SOUTH BURLINGTON, VT 054072343 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $23K | — | $23K | 7.59% |
| COPE, TIMOTHY L3 | 620 HINESBURG ROAD PO BOX 2127 SOUTH BURLINGTON, VT 05407 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $333 | $2K | 12.02% |
| NFP INSURANCE SERVICES INC3 | 1250 CAPITAL OF TX HWY S BLDG II STE 600 AUSTIN, TX 78746 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $277 | $277 | 1.55% |
| COPE, TIMOTHY L3 | 620 HINESBURG RD PO BOX 2127 SOUTH BURLINGTON, VT 05407 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $265 | $2K | 16.52% |
| NFP INSURANCE SERVICES INC3 | 1250 CAPITAL OF TX HWY S BLDG II STE 600 AUSTIN, TX 78746 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $221 | $221 | 1.54% |
| COPE, TIMOTHY L3 | 620 HINESBURG ROAD PO BOX 2127 SOUTH BURLINGTON, VT 05407 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $579 | $97 | $676 | 12.85% |
| NFP INSURANCE SERVICES INC3 | 1250 CAPITAL OF TX HWY S BLDG II STE 600 AUSTIN, TX 78746 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $81 | $81 | 1.54% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $27K |
| CBA BLUE EIN 03-0360451 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $8K |
| FLEISCHER JACOBS GROUP BROKER | Insurance agents and brokers Service code 22 | PO BOX 2343 SOUTH BURLINGTON, VT 054072343 | $2K |
| CIGNA | Contract Administrator; Non-monetary compensation; Named fiduciary; Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan Service code 12 | — | $0 |
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 | 98 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 99 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 119 | $301K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 103 | $5K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 104 | $18K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 104 | $14K |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 103 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 119 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.