| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LUMITY, INC.3 Filed as: LUMITY INC | 71 EAST 3RD AVE SAN MATEO, CA 94401 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $310 | — | $310 | 0.12% |
| LUMITY, INC.3 Filed as: LUMITY INC | 71 EAST 3RD AVE SAN MATEO, CA 94401 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $826 | $120 | $946 | 11.45% |
| BENEFITMALL3 | 12404 PARK CENTRAL DRIVE SUITE 4005 DALLAS, TX 75251 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $413 | $413 | 5.00% |
| LUMITY, INC.3 Filed as: LUMITY INC | 71 EAST 3RD AVE SAN MATEO, CA 94401 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $664 | $104 | $768 | 11.57% |
| BENEFITMALL3 | 12404 PARK CENTRAL DRIVE SUITE 4005 DALLAS, TX 75251 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $332 | $332 | 5.00% |
| LUMITY, INC.3 Filed as: LUMITY INC | 71 EAST 3RD AVE SAN MATEO, CA 94401 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $648 | $195 | $843 | 13.01% |
| BENEFITMALL3 | 12404 PARK CENTRAL DRIVE SUITE 4005 DALLAS, TX 75251 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $324 | $324 | 5.00% |
| LUMITY, INC.3 Filed as: LUMITY INC | 71 EAST 3RD AVE SAN MATEO, CA 94401 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $165 | $24 | $189 | 11.47% |
| BENEFITMALL3 | 12404 PARK CENTRAL DRIVE SUITE 4005 DALLAS, TX 75251 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $82 | $82 | 4.98% |
No Schedule C service providers reported on this filing.
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 | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 119 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 112 | $255K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 112 | $255K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 112 | $255K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 116 | $8K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 116 | $7K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 44 | $6K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 112 | $255K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 116 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 116 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.