| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK BREEN3 | 12940 STATE RD NORTH ROYALTON, OH 44133 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $17K | — | $17K | 2.24% |
| BREEN, MARK F3 | 12940 STATE RD NORTH ROYALTON, OH 44133 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | — | $13K | 11.14% |
| BREEN, MARK F3 | 12940 STATE RD NORTH ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $15K | — | $15K | 15.00% |
| BREEN, MARK F3 Filed as: BREEN, MARK, F | 12940 STATE RD NORTH ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 9.46% |
| SMITH, THOMAS, CHRISTOPHER3 | 798 BERRY RD PO BOX 40386 NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $172 | $3K | 4.32% |
| BREEN, MARK F3 | 12940 STATE RD NORTH ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 7.08% |
| BREEN, MARK F3 Filed as: BREEN, MARK, F | 12940 STATE RD NORTH ROYALTON, OH 44133 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 7.46% |
| SMITH, THOMAS, CHRISTOPHER3 | 798 BERRY RD PO BOX 40386 NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $135 | $2K | 5.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 CLAIMS PROCESSING | Participant communication; Float revenue; Named fiduciary; Contract Administrator; Non-monetary compensation; Claims processing; Other services; Direct payment from the plan Service code 12 | — | $308K |
| MARK BREEN INS AGENTS AND BROKERS | Insurance agents and brokers Service code 22 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | $58K |
| CIGNA | Direct payment from the plan; Named fiduciary; Participant communication; Other services; Claims processing; Non-monetary compensation; Contract Administrator; Float revenue Service code 12 | — | $0 |
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 | 699 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 714 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 965 | $780K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 965 | $780K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 699 | $188K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 699 | $113K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 699 | $113K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 965 | $780K |
| Other(5 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 699 | $365K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 965 | — |
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.