| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KENNETH NICHOLS3 | 116 SANTIAGO DRIVE JUPITER, FL 33458 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $16K | — | $16K | 7.45% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS. FIN. DBA BENEFIT M | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 75251 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $11K | $11K | 4.95% |
| KENNETH NICHOLS3 | 116 SANTIAGO DRIVE JUPITER, FL 33458 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | — | $8K | 10.75% |
| BENEFITMALL3 | 354 EISENHOWER PKWY STE 2850 LIVINGSTON, NJ 07039 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $4K | $4K | 5.00% |
| KENNETH NICHOLS3 | 116 SANTIAGO DRIVE JUPITER, FL 33458 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 5.80% |
| BENEFITMALL3 | 354 EISENHOWER PKWY STE 2850 LIVINGSTON, NJ 07039 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 5.00% |
| KENNETH NICHOLS3 | 116 SANTIAGO DRIVE JUPITER, FL 33458 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 13.00% |
| BENEFITMALL3 | 354 EISENHOWER PKWY LIVINGSTON, NJ 07039 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 5.00% |
| KENNETH NICHOLS3 | 116 SANTIAGO DRIVE JUPITER, FL 33458 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $434 | — | $434 | 11.99% |
| BENEFITMALL3 | 354 EISENHOWER PKWY STE 2850 LIVINGSTON, NJ 07039 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $181 | $181 | 5.00% |
| KENNETH NICHOLS3 | 116 SANTIAGO DRIVE JUPITER, FL 33458 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $295 | — | $295 | 10.00% |
| BENEFIT MALL3 | 354 EISENHOWER PKWY STE 2850 LIVINGSTON, NJ 07039 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | — | $148 | $148 | 5.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KENNETH C NICHOLS BROKER | Insurance brokerage commissions and fees Service code 53 | 116 SANTIAGO DRIVE JUPITER, FL 33458 | $186K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIMS ADMINISTRATOR | Contract Administrator; Non-monetary compensation; Direct payment from the plan; Other services; Participant communication; Named fiduciary; Claims processing; Float revenue Service code 12 | — | $128K |
| CENTERSTONE INS & FIN SVC LLC GENERAL AGENT | Insurance brokerage commissions and fees Service code 53 | 354 EISENHOWER PKWY STE 2850 LIVINGSTON, NJ 07039 | $83K |
| CIGNA | Direct payment from the plan; Named fiduciary; Float revenue; Other services; Claims processing; Non-monetary compensation; Contract Administrator; Participant communication 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 | 294 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 295 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 247 | $216K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 247 | $216K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 315 | $71K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 294 | $64K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 140 | $45K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 294 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 315 | — |
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.