No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIM ADMINISTRATOR | Contract Administrator; Direct payment from the plan; Other services; Participant communication; Claims processing; Non-monetary compensation; Named fiduciary; Float revenue Service code 12 | — | $6K |
| CIGNA | Direct payment from the plan; Float revenue; Contract Administrator; Non-monetary compensation; Claims processing; Named fiduciary; Participant communication; Other services 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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CIGNA BEHAVIORAL HEALTH INC | 67 | $3K |
| Dental | CIGNA/SELF INSURED MEDICAL & DENTAL | 67 | $0 |
| Vision | FIDELITY SECURITY LIFE INSURANCE/EYEMED | 67 | $8K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA/SELF INSURED MEDICAL & DENTAL | 67 | $0 |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF ILLINOIS | 67 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 67 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.