| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES INC | 2677 ROCHELLE PLACE SIMI VALLEY, CA 93063 | CIGNA HEALTH AND LIFE INSURANCE CO AND AFFILIATES | $8K | $0 | $8K | 6.58% |
| FOUNDATION RISK PARTNERS CORP3 | 141 W GREEN STREET PASADENA, CA 91105 | CIGNA HEALTH AND LIFE INSURANCE CO AND AFFILIATES | $4K | $0 | $4K | 3.35% |
| AUSTIN & CO INC3 Filed as: AUSTIN AND CO INC | 20 CORPORATE WOODS BLVD ALBANY, NY 12211 | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | $3K | $0 | $3K | 6.88% |
| AUSTIN & CO INC3 Filed as: AUSTIN AND CO INC | 20 CORPORATE WOODS BLVD ALBANY, NY 12211 | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | $1K | $0 | $1K | 11.49% |
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK PARTNERS | 4634 GULFSTARR DRIVE DESTIN, FL 32541 | VISION SERVICE PLAN | $546 | $0 | $546 | 6.21% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES | 4634 GULFSTARR DRIVE DESTIN, FL 32541 | VISION SERVICE PLAN | $286 | $0 | $286 | 3.26% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CONTRACT ADMIN | Contract Administrator Service code 13 | — | $34K |
| WEX HEALTH INC. EIN 06-1593514 CONTRACT ADMIN | Contract Administrator Service code 13 | — | $3K |
| CIGNA | Participant communication; Named fiduciary; Other services; Non-monetary compensation; Claims processing; Contract Administrator; Float revenue; Direct payment from the plan 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 | 116 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE CO AND AFFILIATES | 114 | $129K |
| Vision | VISION SERVICE PLAN | 69 | $9K |
| Life insurance | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | 124 | $11K |
| Long-term disability | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | 91 | $39K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 168 | $767K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 168 | — |
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.