| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 300 MAIN STREET SUITE 1300 NORFOLK, VA 23510 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $12K | — | $12K | 1.10% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $5K | — | $5K | 1.73% |
| USI INSURANCE SERVICES LLC3 | 300 MAIN STREET SUITE 1300 NORFOLK, VA 23510 | CIGNA LIFE INSURANCE CO. OF NEW YORK | — | $545 | $545 | 0.19% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $11K | — | $11K | 5.00% |
| USI INSURANCE SERVICES LLC3 | 300 EAST MAIN STREET SUITE 1300 NORFOLK, VA 23510 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $0 | $330 | $330 | 0.15% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $7K | $0 | $7K | 5.37% |
| USI INSURANCE SERVICES LLC3 | 300 EAST MAIN STREET SUITE 1300 NORFOLK, VA 23510 | CIGNA LIFE INSURANCE CO. OF NEW YORK | — | $269 | $269 | 0.20% |
| FRED C. CHURCH INC.3 | 41 WELLMAN STREET LOWELL, MA 01851 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $4K | — | $4K | 8.49% |
| USI INSURANCE SERVICES LLC3 | 300 EAST MAIN STREET SUITE 1300 NORFOLK, VA 23510 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $0 | $83 | $83 | 0.17% |
| MIKE SLADE3 | 8215 ROYAL SAINT GEORGES WAY DULUTH, GA 30097 | LEGALPLANS, USA | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMIN | Participant communication; Other services; Non-monetary compensation; Claims processing; Contract Administrator; Float revenue; Direct payment from the plan Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $822K |
| WAGEWORKS EIN 94-3351864 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | 1100 PARK PLACE SAN MATEO, CA 94403 | $25K |
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 | 1,522 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,522 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,195 | $1.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,195 | $1.1M |
| Vision(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,248 | $1.2M |
| Life insurance | CIGNA LIFE INSURANCE CO. OF NEW YORK | 1,522 | $213K |
| Short-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 1,522 | $281K |
| Long-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 1,522 | $134K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,195 | $1.1M |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,195 | $1.1M |
| Other(4 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,195 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,248 | — |
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."
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.