| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RSC INSURANCE BROKERAGE INC3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $83K | $0 | $83K | 6.26% |
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL ST 4TH FLOOR BOSTON, MA 02110 | DELTA DENTAL OF NEW JERSEY, INC | $13K | $0 | $13K | 5.02% |
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL STREET FL 4 BOSTON, MA 02110 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $13K | $0 | $13K | 11.97% |
| SELMAN & COMPANY, LLC3 Filed as: SELMAN & COMPANY,LLC | 1 INTEGRITY PKWY CLEVELAND, OH 44143 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $5K | $5K | 5.00% |
| RSC INSURANCE BROKERAGE INC3 | 700 AIRPORT BLVD STE 300 BURLINGAME, CA 94010 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $4K | $4K | 3.57% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC | 160 FEDERAL ST 4TH FL BOSTON, MA 02110 | VISION SERVICE PLAN | $1K | $0 | $1K | 4.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 ADMINISTRATOR | Named fiduciary; Float revenue; Other services; Non-monetary compensation; Participant communication; Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $494K |
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 | 281 | 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) | 281 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 180 | $1.3M |
| Dental | DELTA DENTAL OF NEW JERSEY, INC | 221 | $259K |
| Vision | VISION SERVICE PLAN | 204 | $30K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 281 | $108K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 281 | $108K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 281 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.