| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST - DALLAS TX | P O BOX 61187 VIRGINIA BEACH, VA 23466 | FIRST AMERICAN ADMINISTRATORS INC | — | $6K | $6K | 5.63% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 NONE | Contract Administrator; Participant communication; Named fiduciary; Claims processing; Non-monetary compensation; Direct payment from the plan; Float revenue; Other services Service code 12 | — | $790K |
| RESPONSEWORKS, INC EIN 22-3563649 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $38K |
| WAGNER & ZWERMAN EIN 11-2836481 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $21K |
| DELTA DENTAL OF NY EIN 11-1980218 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $10K |
| CIGNA HEALTH & INSURANCE CO 59-1031 | Non-monetary compensation; Float revenue; Claims processing; Other services; Contract Administrator; Direct payment from the plan; Participant communication; Named fiduciary Service code 12 | — | $0 |
| CIGNA HEALTH & LIFE INSURANCE CO 59 | Contract Administrator; Direct payment from the plan; Claims processing; Other services; Participant communication; Named fiduciary; Non-monetary compensation; Float revenue Service code 12 | — | $0 |
| CIGNA HEALTH AND LIFE INSURANCE CO | Non-monetary compensation; Named fiduciary; Participant communication; Float revenue; Direct payment from the plan; Contract Administrator; Other services; 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 | 1,435 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,451 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC. | 61 | $685K |
| Vision | FIRST AMERICAN ADMINISTRATORS INC | 2,393 | $102K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,701 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,701 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.