| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK BREEN3 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | CIGNA | $18K | — | $18K | 2.16% |
| MARK BREEN3 | 12940 STATE ROAD N ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | $0 | $13K | 15.00% |
| MARK BREEN3 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $0 | $8K | 11.31% |
| SMITH, THOMAS, CHRISTOPHER3 Filed as: SMITH, THOMAS , CHRISTOPHER | P.O. BOX 6650 METAIRIE, LA 70009 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $260 | $4K | 5.09% |
| MARK BREEN3 Filed as: MARK F. BREEN | 12940 STATE ROAD N ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 7.22% |
| MARK BREEN3 Filed as: MARK F. BREEN | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | PROVIDENT LIFE AND ACCIDENT INSURANCE | $4K | — | $4K | 9.88% |
| SMITH, THOMAS, CHRISTOPHER3 Filed as: SMITH, THOMAS , CHRISTOPHER | P.O. BOX 6650 METAIRIE, LA 70009 | PROVIDENT LIFE AND ACCIDENT INSURANCE | $3K | $221 | $3K | 7.47% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 06-0303370 CLAIM ADMINISTRATION | Participant communication; Float revenue; Claims processing; Non-monetary compensation; Contract Administrator; Named fiduciary; Other services; Direct payment from the plan Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $379K |
| MARK BREEN INSURANCE AGENT\BROKER | Other fees Service code 99 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | $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 | 1,046 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,046 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA | 1,046 | $824K |
| Vision | CIGNA | 1,046 | $824K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 556 | $171K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 556 | $43K |
| Stop-loss / reinsurancereinsurance | CIGNA | 1,046 | $824K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 556 | $114K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,046 | — |
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."
No prospect flags tripped on this filing.