| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SELMAN & COMPANY, LLC3 Filed as: SELMAN & CO | 6110 PARKLAND BLVD CLEVELAND, OH 44124 | THE HARTFORD | $0 | $2K | $2K | 0.01% |
| RICHARD F. KIEFNER3 Filed as: RICHARD KIEFNER JR | 1356 WILLOW WOOD DRIVE NORFOLK, VA 23509 | OPTIMA HEALTH | $60K | $0 | $60K | 0.53% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 NONE | Contract Administrator Service code 13 | — | $18.0M |
| HEWITT ASSOCIATES LLC EIN 36-2235791 NONE | Consulting fees; Actuarial; Consulting (general); Consulting (pension); Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees Service code 11 | — | $4.8M |
| DELTA DENTAL OF VIRGINIA EIN 54-0844477 NONE | Contract Administrator Service code 13 | — | $986K |
| SUMMIT HEALTH EIN 20-1908041 NONE | Other services; Direct payment from the plan Service code 49 | — | $683K |
| ADVANCE MEDICAL EIN 32-0188784 NONE | Other services Service code 49 | — | $333K |
| GROOM LAW GROUP EIN 52-1219029 NONE | Legal Service code 29 | — | $206K |
| HIGHROADS, INC. EIN 52-2218774 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $196K |
| NATURALLY SLIM EIN 26-2868596 NONE | Other services Service code 49 | — | $195K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 NONE | Claims processing; Participant communication; Contract Administrator; Direct payment from the plan Service code 12 | — | $135K |
| BUDCO HEALTH SERVICES SOLUTIONS EIN 38-1622051 NONE | Other services; Consulting fees; Participant communication; Other fees Service code 38 | — | $122K |
| JP MORGAN EIN 13-4994650 NONE | Investment advisory (plan); Float revenue; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $111K |
| KPMG LLP EIN 13-1673581 NONE | Accounting (including auditing) Service code 10 | — | $59K |
| PEGGY EDGE CPA EIN 26-4527814 NONE | Accounting (including auditing) Service code 10 | — | $15K |
| FOUNDATION MEDICAL PARTNERS EIN 02-0456218 NONE | Other services Service code 49 | — | $12K |
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 | 30,412 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 946 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 31,358 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(8 contracts, 7 carriers) | OPTIMA HEALTH | 12,803 | $27.8M |
| Dental(5 contracts, 5 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 1,219 | $6.2M |
| Vision | VISION SERVICE PLAN | 20,758 | $3.5M |
| Life insurance | THE HARTFORD | 31,417 | $22.9M |
| Short-term disability(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,970 | $266K |
| Other(3 contracts, 3 carriers) | THE HARTFORD | 31,417 | $26.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 31,417 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.