| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CORESOURCE, INC.3 Filed as: CORESOURCE CORPORATE HEADQUARTERS | 400 FIELD DRIVE LAKE FOREST, IL 60045 | UNIMERICA INSURANCE COMPANY | $7K | $0 | $7K | 3.00% |
| CCAB INSURANCE & BENEFITS, INC.3 Filed as: CCAB INSURANCE & BENEFITS | 2101 OREGON PIKE, SUITE 202 LANCSTER, PA 17601 | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | $2K | $0 | $2K | 10.18% |
| CCAB INSURANCE & BENEFITS, INC.3 Filed as: CCAB INSURANCE & BENEFITS | 2101 OREGON PIKE, SUITE 202 LANCASTER, PA 17601 | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | $2K | $0 | $2K | 12.10% |
| CCAB INSURANCE & BENEFITS, INC.3 | 2101 OREGON PIKE, SUITE 202 LANCASTER, PA 17601 | VISION BENEFITS OF AMERICA | $301 | $0 | $301 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRUSTMARK HEALTH BENEFITS, INC EIN 35-1846036 ADMIN | Other services; Plan Administrator; Claims processing Service code 12 | — | $47K |
| CIGNA EIN 59-1031071 ADMIN | Other services; Claims processing Service code 12 | — | $16K |
| DELTA EIN 23-1667011 ADMIN | Claims processing Service code 12 | — | $4K |
| LINCOLN LIFE ASSURANCE COMPANY EIN 04-6076039 ADMIN | Claims processing Service code 12 | — | $4K |
| RXBENEFITS, INC. EIN 63-1157085 ADMIN | Claims processing Service code 12 | — | $1K |
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 | 115 | 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) | 115 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION BENEFITS OF AMERICA | 28 | $3K |
| Life insurance | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | 115 | $23K |
| Long-term disability | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | 115 | $12K |
| Stop-loss / reinsurancereinsurance | UNIMERICA INSURANCE COMPANY | 99 | $222K |
| Other | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | 115 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 115 | — |
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.