| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STAR RISK SERVICES, INC. | 536 SILICON DR STE 103 SOUTHLAKE, TX 760929020 | VISION SERVICE PLAN | $17K | — | $17K | 9.16% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 NONE | Non-monetary compensation; Named fiduciary; Participant communication; Float revenue; Direct payment from the plan; Contract Administrator; Other services; Claims processing Service code 12 | — | $911K |
| DELTA DENTAL OF NY EIN 11-1980218 NONE | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $68K |
| RESPONSEWORKS, INC EIN 22-3563649 NONE | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $36K |
| WAGNER & ZWERMAN EIN 11-2836481 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $17K |
| CIGNA HEALTH & LIFE INSURANCE CO 59 | Contract Administrator; Named fiduciary; Participant communication; Direct payment from the plan; Other services; Float revenue; Claims processing; Non-monetary compensation Service code 12 | — | $96 |
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 | 1,273 | Currently employed and enrolled or eligible. |
| Retired/separated still eligible | 31 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,304 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC. | 76 | $661K |
| Vision | VISION SERVICE PLAN | 1,061 | $185K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,573 | $717K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,573 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.