| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS,LLC | 7501 W. MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 3.00% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS,LLC | 7501 W. MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $962 | $962 | 3.00% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 701 B ST. 6TH FL SAN DIEGO, CA 92101 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 13.55% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS,LLC | 7501 W. MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $458 | $458 | 3.00% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 701 B ST. 6TH FL SAN DIEGO, CA 92101 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 13.56% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 701 B ST. 6TH FL SAN DIEGO, CA 92101 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | — | $1K | 13.58% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS,LLC | 7501 W. MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $193 | $193 | 3.00% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 7231 FOREST AVENUE SUITE 205 RICHMOND, VA 23226 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $181 | — | $181 | 10.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS COMPANY EIN 59-1031071 CLAIM PROCESSING | Claims processing Service code 12 | — | $69K |
| CIGNA | Named fiduciary; Non-monetary compensation; Other services; Claims processing; Float revenue; Participant communication; Contract Administrator; Direct payment from the plan 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 | 325 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 326 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 188 | $317K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 205 | $107K |
| Vision(2 contracts) | VISION SERVICE PLAN | 190 | $11K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 325 | $51K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 325 | $34K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 325 | $15K |
| Other(4 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 325 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 325 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.