| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK BREEN3 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | CIGNA | $16K | — | $16K | 2.17% |
| MARK BREEN3 | 12940 STATE ROAD N ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 15.00% |
| MARK BREEN3 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 12.90% |
| SMITH, THOMAS, CHRISTOPHER3 Filed as: SMITH, THOMAS , CHRISTOPHER | P.O. BOX 6650 METAIRIE, LA 70009 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $339 | $4K | 5.48% |
| MARK BREEN3 Filed as: MARK F. BREEN | 12940 STATE ROAD N ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 7.45% |
| MARK BREEN3 Filed as: MARK F. BREEN | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | PROVIDENT LIFE AND ACCIDENT INSURANCE | $4K | — | $4K | 10.70% |
| SMITH, THOMAS, CHRISTOPHER3 Filed as: SMITH, THOMAS , CHRISTOPHER | P.O. BOX 6650 METAIRIE, LA 70009 | PROVIDENT LIFE AND ACCIDENT INSURANCE | $2K | $181 | $3K | 6.35% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 06-0303370 CLAIM ADMINISTRATION | Non-monetary compensation; Claims processing; Contract Administrator; Named fiduciary; Float revenue; Participant communication; Other services; Direct payment from the plan Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $349K |
| MARK BREEN INSURANCE AGENT\BROKER | Other fees Service code 99 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | $58K |
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 | 944 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 944 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA | 944 | $726K |
| Vision | CIGNA | 944 | $726K |
| Life insurance(4 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 621 | $173K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 621 | $51K |
| Stop-loss / reinsurancereinsurance | CIGNA | 944 | $726K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 621 | $123K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 944 | — |
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.