| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LUIS LOPEZ LUNA3 | CALLE J#21 URB. VILLA CAPARRA GUAYNABO, PR 00966 | MCS LIFE INSURANCE COMPANY | $20K | — | $20K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 THIRD PARTY ADMIN. | Named fiduciary; Other services; Contract Administrator; Participant communication; Float revenue; Non-monetary compensation; Direct payment from the plan; Claims processing Service code 12 | — | $2.0M |
| EXPRESS SCRIPTS CONTRACT ADMIN | Claims processing Service code 12 | ONE EXPRESS WAY ST LOUIS, MO 63121 | $188K |
| KPMG, LLP AUDITOR | Accounting (including auditing) Service code 10 | DEPT 0579 PO BOX 120001 DALLAS, TX 75312 | $49K |
| BENEFIT CONCEPTS, INC CONTRACT ADMIN | Claims processing Service code 12 | 20 RISHO DRIVE EAST PROVIDENCE, RI 02914 | $33K |
| CIGNA | Non-monetary compensation; Direct payment from the plan; Contract Administrator; Other services; Participant communication; Named fiduciary; Claims processing; Float revenue 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 | 5,795 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 321 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 145 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 6,261 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MCS LIFE INSURANCE COMPANY | 62 | $395K |
| Dental | MCS LIFE INSURANCE COMPANY | 62 | $395K |
| Vision | EYEMED VISION CARE | 7,120 | $423K |
| Life insurance(2 contracts, 2 carriers) | UNICARE | 6,781 | $3.1M |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 5,728 | $1.5M |
| Other | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 5,810 | $494K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,120 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
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.