| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STAR RISK SERVICES, INC. | 536 SILICON DR STE 103 SOUTHLAKE, TX 760929020 | VISION SERVICE PLAN | $10K | — | $10K | 5.89% |
| LOCKTON COMPANIES, LLC | PO BOX 843844 KANSAS CITY, MO 641849020 | VISION SERVICE PLAN | $7K | — | $7K | 4.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 NONE | Contract Administrator; Direct payment from the plan; Other services; Participant communication; Non-monetary compensation; Claims processing; Named fiduciary; Float revenue Service code 12 | — | $727K |
| DELTA DENTAL OF NY EIN 11-1980218 NONE | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $69K |
| RESPONSEWORKS, INC EIN 22-3563649 NONE | Contract Administrator; Claims processing; Direct payment from the plan Service code 12 | — | $37K |
| WAGNER & ZWERMAN EIN 11-2836481 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $19K |
| CIGNA HEALTH & LIFE INSURANCE CO 59 | Named fiduciary; Other services; Contract Administrator; Participant communication; Float revenue; Non-monetary compensation; Direct payment from the plan; 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 | 1,319 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 23 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,342 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC. | 61 | $664K |
| Vision | VISION SERVICE PLAN | 1,100 | $164K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,597 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,597 | — |
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.