| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | $1K | $6K | 24.77% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $608 | $4K | 19.10% |
| DONALD E WISE3 | 2319 N HAMILTON AVE APT 4 CHICAGO, IL 60647 | STARMOUNT LIFE INSURANCE COMPANY | $566 | — | $566 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIMS ADMINISTRATOR | Insurance services; Claims processing Service code 12 | — | $42K |
| DIGITAL INSURANCE LLC BROKER | Insurance agents and brokers Service code 22 | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | $33K |
| ENVISION HEALTHCARE, INC. THIRD PARTY ADMINISTRATO | Claims processing Service code 12 | PO BOX 5047 OAK BROOK, IL 60522 | $12K |
| ROGERS BENEFIT GROUP INC BROKER | Insurance agents and brokers Service code 22 | 2340 DES PLAINES RIVER RD UNIT 211 DES PLAINES, IL 60018 | $11K |
| CIGNA | Direct payment from the plan; Named fiduciary; Claims processing; Other services; Participant communication; Float revenue; Non-monetary compensation; Contract Administrator 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 | 134 | 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) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 103 | $21K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 62 | $6K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 147 | $23K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 138 | $342K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 147 | — |
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.