| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK BREEN3 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | CIGNA | $10K | — | $10K | 1.88% |
| MARK BREEN3 Filed as: MARK F. BREEN | 12940 STATE ROAD N ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 8.25% |
| MARK BREEN3 | 12940 STATE ROAD N ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $0 | $11K | 15.00% |
| MARK BREEN3 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $0 | $10K | 16.88% |
| SMITH, THOMAS, CHRISTOPHER3 Filed as: SMITH, THOMAS , CHRISTOPHER | P.O. BOX 6650 METAIRIE, TN 70009 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $277 | $4K | 6.92% |
| MARK BREEN3 Filed as: MARK F. BREEN | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | PROVIDENT LIFE AND ACCIDENT INSURANCE | $11K | $0 | $11K | 31.66% |
| SMITH, THOMAS, CHRISTOPHER3 Filed as: SMITH, THOMAS , CHRISTOPHER | P.O. BOX 6650 METAIRIE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE | $5K | $80 | $5K | 13.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 06-0303370 CLAIM ADMINISTRATION | Contract Administrator; Named fiduciary; Participant communication; Direct payment from the plan; Other services; Float revenue; Claims processing; Non-monetary compensation Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $290K |
| MARK BREEN INSURANCE AGENT\BROKER | Other fees Service code 99 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | $46K |
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 | 837 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 837 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA | 837 | $556K |
| Vision | CIGNA | 837 | $556K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 563 | $195K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 563 | $89K |
| Stop-loss / reinsurancereinsurance | CIGNA | 837 | $556K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 563 | $148K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 837 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.