| 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 | $9K | — | $9K | 6.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST - DALLAS TX | PO BOX 61187 VIRGINIA BEACH, VA 23466 | FIRST AMERICAN ADMINISTRATORS INC | $90 | — | $90 | 5.64% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 NONE | Non-monetary compensation; Claims processing; Participant communication; Contract Administrator; Named fiduciary; Direct payment from the plan; Other services; Float revenue Service code 12 | — | $779K |
| RESPONSEWORKS, INC EIN 22-3563649 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $38K |
| CIGNA HEALTH & INSURANCE CO 59-1031 | Other services; Direct payment from the plan; Contract Administrator; Participant communication; Float revenue; Named fiduciary; Non-monetary compensation; Claims processing Service code 12 | — | $0 |
| CIGNA HEALTH & LIFE INSURANCE CO 59 | Non-monetary compensation; Other services; Participant communication; Claims processing; Direct payment from the plan; Contract Administrator; Float revenue; Named fiduciary Service code 12 | — | $0 |
| CIGNA HEALTH AND LIFE INSURANCE CO | Participant communication; Other services; Contract Administrator; Non-monetary compensation; Named fiduciary; Float revenue; 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 | 2,638 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,642 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC. | 62 | $592K |
| Vision(2 contracts) | FIRST AMERICAN ADMINISTRATORS INC | 2,388 | $147K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,636 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,636 | — |
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.