| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK BREEN3 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | CIGNA | $8K | — | $8K | 1.92% |
| MARK BREEN3 Filed as: MARK F. BREEN | 12940 STATE ROAD N ROYALTON, OH 44133 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $6K | — | $6K | 15.00% |
| MARK BREEN3 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| MARK BREEN3 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 06-0303370 CLAIM ADMINISTRATION | Named fiduciary; Float revenue; Claims processing; Non-monetary compensation; Contract Administrator; Other services; Direct payment from the plan; Participant communication Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $193K |
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 | 581 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 581 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA | 581 | $435K |
| Vision | CIGNA | 581 | $435K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 395 | $20K |
| Long-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 376 | $27K |
| Stop-loss / reinsurancereinsurance | CIGNA | 581 | $435K |
| Other(2 contracts) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 395 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 581 | — |
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.