| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VISION SERVICE PLAN | 2000 TOWN CENTER SUITE 725 SOUTHFIELD, MI 48075 | VISION SERVICE PLAN | — | $69K | $69K | 19.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $1.2M |
| NGS AMERICAN EIN 38-2259531 CONTRACT ADMINISTRATOR | Plan Administrator Service code 14 | PO BOX 2310 MT. CLEMENS, MI 48046 | $62K |
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 | 2,500 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 2,500 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 18 | $142K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 18 | $142K |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 1,700 | $503K |
| Life insurance(2 contracts) | MINNESOTA LIFE INSURANCE COMPANY | 2,560 | $700K |
| Long-term disability | THE HARTFORD | 60 | $13K |
| Stop-loss / reinsurancereinsurance | AETNA LIFE INSURANCE COMPANY | 2,100 | $1.1M |
| Other(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 2,500 | $211K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,560 | — |
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.