| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MISSOURI, LLC | 12645 OLIVE BLVD STE 300 ST LOUIS, MO 63141 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $23K | — | $23K | 5.00% |
| BREEN, MARK F3 | 12940 STATE RD NORTH ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF NORTH AMERICA | $20K | — | $20K | 12.56% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MISSOURI LLC | 12645 OLIVE BLVD STE 300 ST LOUIS, MO 63141 | UNUM LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 2.44% |
| MARK BREEN3 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | — | $12K | 8.18% |
| BREEN, MARK F3 | 12940 STATE RD NORTH ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $15K | — | $15K | 14.79% |
| SMITH, THOMAS, CHRISTOPHER3 Filed as: SMITH, THOMAS CHRISTOPHER | PO BOX 40386 798 BERRY RD NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $441 | $7K | 6.81% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MISSOURI LLC | 12645 OLIVE BLVD STE 300 ST LOUIS, MO 63141 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $71 | — | $71 | 0.07% |
| BREEN, MARK F3 | 12940 STATE RD ROYALTON, OH 44133 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | — | $7K | 10.04% |
| SMITH, THOMAS, CHRISTOPHER3 Filed as: SMITH, THOMAS CHRISTOPHER | PO BOX 40386 798 BERRY RD NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $327 | $6K | 8.28% |
| BREEN, MARK F3 | 12940 STATE RD NORTH ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 5.21% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MISSOURI LLC | 12645 OLIVE BLVD STE 300 ST LOUIS, MO 63141 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $106 | — | $106 | 0.16% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MISSOURI LLC | 12645 OLIVE BLVD SUITE 300 ST. LOUIS, MO 63141 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 11.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 MEDICAL FEES | Non-monetary compensation; Contract Administrator; Float revenue; Claims processing; Named fiduciary; Direct payment from the plan; Participant communication; Other services Service code 12 | — | $271K |
| BREEN, MARK F MEDICAL BROKER | Insurance brokerage commissions and fees Service code 53 | 12940 STATE RD NORTH ROYALTON, OH 44133 | $55K |
| ASSUREDPARTNERS OF MISSOURI, LLC MEDICAL BROKER | Insurance brokerage commissions and fees Service code 53 | 12645 OLIVE BLVD STE 300 ST LOUIS, MO 63141 | $26K |
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 | 769 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 22 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 802 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,238 | $468K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,238 | $468K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 769 | $68K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 685 | $13K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 685 | $151K |
| Other(5 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF NORTH AMERICA | 769 | $392K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,238 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.