| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EBS INSURANCE BROKERS3 Filed as: EBS INSURANCE BROKERS INC | 1 GATEWAY CTR STE 650 NEWTON, MA 02458 | HARTFORD LIFE AND ACCIDENT | — | $23K | $23K | 1.20% |
| SELMAN & COMPANY, LLC5 Filed as: SELMAN & CO INC | 6110 PARKLAND BLVD CLEVELAND, OH 441244187 | HARTFORD LIFE AND ACCIDENT | — | $2K | $2K | 0.10% |
| CHRISTINE M. MCCULLUGH3 Filed as: CHRISTINE MCCULLUGH | STE 300 16310 NE 80TH ST REDMOND, WA 98052 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $31K | — | $31K | 14.90% |
No Schedule C service providers reported on this filing.
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 | 1,381 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,132 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,513 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 613 | $437K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 613 | $437K |
| Vision(2 contracts) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 1,543 | $123K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 3,043 | $1.9M |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 3,043 | $1.9M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 3,043 | $1.9M |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 613 | $437K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 3,043 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,043 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.