| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PLATINUM PLANNING INC3 | 718 RIVER ROAD FAIR HAVE, NJ 07704 | CIGNA HEALTH AND LIFE INSURANCE CO. | $2K | $2K | $4K | 8.21% |
| PLATINUM PLANNING INC3 Filed as: PLATINUM PLANNING INC. | 718 RIVER ROAD FAIR HAVEN, NJ 07704 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $423 | — | $423 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PLATINUM PLANNING INC. INSURANCE BROKER | Consulting fees Service code 70 | 718 RIVER ROAD FAIR HAVEN, NJ 07704 | $38K |
| AMERICAN SPECIALTY HEALTH SERVICE PROVIDER | Claims processing; Contract Administrator; Named fiduciary; Participant communication; Float revenue; Other services; Non-monetary compensation; Direct payment from the plan Service code 12 | 10221 WATERIDGE CIRCLE SUITE 201 SAN DIEGO, CA 92121 | $0 |
| CARECORE DBA EVICORE SERVICE PROVIDER | Non-monetary compensation; Contract Administrator; Direct payment from the plan; Participant communication; Claims processing; Float revenue; Named fiduciary; Other services Service code 12 | 400 BUCKWALTER PLACE BLVD. BLUFFON, SC 29910 | $0 |
| MEDSOLUTIONS DBA EVICORE SERVICE PROVIDER | Float revenue; Participant communication; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Claims processing; Other services; Named fiduciary Service code 12 | 730 COOL SPRINGS BLVD #800 FRANKLIN, TN 37067 | $0 |
| US BANK NATIONAL ASSOCIATION SERVICE PROVIDER | Named fiduciary; Claims processing; Participant communication; Float revenue; Non-monetary compensation; Direct payment from the plan; Contract Administrator; Other services Service code 12 | 800 NICHOLLET MALL MINNEAPOLIS, MN 55042 | $0 |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 SERVICE PROVIDER | Contract Administrator; Direct payment from the plan; Named fiduciary; Float revenue; Other services; Non-monetary compensation; Participant communication; Claims processing Service code 12 | — | -$7K |
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 | 302 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 302 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE CO. | 61 | $49K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE CO. | 61 | $49K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 302 | $8K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 302 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 302 | — |
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.
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.