| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GARY WELTMANN3 | P.O. BOX 59816 POTOMAC, MD 20859 | SUN LIFE & HEALTH INSURANCE COMPANY (U.S.) | $16K | — | $16K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO. EIN 59-1031071 CLAIM ADMINISTRATOR | Named fiduciary; Float revenue; Claims processing; Non-monetary compensation; Contract Administrator; Other services; Direct payment from the plan; Participant communication Service code 12 | 900 COTTAGE GROVE ROAD C3FIN HARTFORD, CT 06152 | $232K |
| CIGNA | Non-monetary compensation; Other services; Float revenue; Participant communication; Contract Administrator; Direct payment from the plan; Named fiduciary; Claims processing 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 | 212 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES (CIGNA) | 551 | $606K |
| Dental | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES (CIGNA) | 551 | $606K |
| Life insurance | SUN LIFE & HEALTH INSURANCE COMPANY (U.S.) | 276 | $0 |
| Prescription drug | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES (CIGNA) | 551 | $606K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES (CIGNA) | 551 | $606K |
| Other(2 contracts, 2 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY & AFFILIATES (CIGNA) | 551 | $606K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 551 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.