| 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 | $21K | — | $21K | 2.34% |
| BREEN, MARK F3 | 12940 STATE RD NORTH ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $18K | — | $18K | 15.00% |
| BREEN, MARK F3 Filed as: BREEN, MARK, F | 12940 STATE RD NORTH ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 12.36% |
| SMITH, THOMAS, CHRISTOPHER3 | 798 BERRY RD PO BOX 40386 NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $237 | $4K | 5.62% |
| BREEN, MARK F3 | 12940 STATE RD NORTH ROYALTON, OH 44133 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3 | — | $3 | 0.01% |
| BREEN, MARK F3 Filed as: BREEN, MARK, F | 12940 STATE RD NORTH ROYALTON, OH 44133 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 7.26% |
| SMITH, THOMAS, CHRISTOPHER3 | 798 BERRY RD PO BOX 40386 NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $165 | $3K | 6.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 CLAIMS PROCESSING | Float revenue; Participant communication; Other services; Non-monetary compensation; Direct payment from the plan; Claims processing; Named fiduciary; Contract Administrator Service code 12 | — | $248K |
| MARK BREEN INS AGENTS AND BROKERS | Insurance agents and brokers Service code 22 | 12940 STATE ROAD NORTH ROYALTON, OH 44133 | $66K |
| CIGNA | Direct payment from the plan; Named fiduciary; Participant communication; Other services; Non-monetary compensation; Claims processing; Float revenue; Contract Administrator 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 | 725 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 39 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 767 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,178 | $973K |
| Vision(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,178 | $973K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 725 | $223K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 616 | $11K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 651 | $7K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,178 | $920K |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 725 | $294K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,178 | — |
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.