| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHAPMAN & CHAPMAN INC | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $10K | — | $10K | 2.33% |
| WALTER CHAPMAN | 2307 E AURORRA RD STE B-13 TWINSBURGH, OH 44087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | — | $7K | 15.00% |
| WALTER CHAPMAN | 2307 E AURORA RD STE B-13 TWINSBURGH, OH 44087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $878 | $0 | $878 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH ANF LIFE INSURANCE COM EIN 59-1031071 ADMIN SERVICE AGREEMENT | Float revenue; Custodial (securities); Direct payment from the plan; Contract Administrator; Non-monetary compensation; Named fiduciary; Participant communication; Claims processing Service code 12 | — | $231K |
| CIGNA | Claims processing; Other services; Direct payment from the plan; Named fiduciary; Non-monetary compensation; Float revenue; Contract Administrator; Participant communication 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 | 475 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 475 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 475 | $448K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 475 | $448K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 380 | $6K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 380 | $46K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 475 | $448K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 475 | $448K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 475 | — |
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.