| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LIPSCOMB & PITTS INSURANCE LLC3 | 2670 UNION AVENUE, SUITE 200 MEMPHIS, TN 38112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $8K | $20K | $28K | 0.66% |
| LIPSCOMB & PITTS INSURANCE LLC3 | 2670 UNION AVENUE, SUITE 200 MEMPHIS, TN 38112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $15K | $18K | 1.57% |
| LIPSCOMB & PITTS INSURANCE LLC3 | 2670 UNION AVENUE, SUITE 200 MEMPHIS, TN 38112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $11K | $11K | 1.43% |
| LIPSCOMB & PITTS INSURANCE LLC3 | 2670 UNION AVENUE, SUITE 200 MEMPHIS, TN 38112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $9K | $12K | 2.09% |
| LIPSCOMB & PITTS INSURANCE LLC3 | 2670 UNION AVENUE, SUITE 200 MEMPHIS, TN 38112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$253 | $2K | $2K | 1.57% |
| LIPSCOMB & PITTS INSURANCE LLC3 | 2670 UNION AVENUE, SUITE 200 MEMPHIS, TN 38112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $90 | $90 | 1.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHIEST YOU EIN 46-1345569 WELLNESS MEMBERSHIP | Other services Service code 49 | 20909 N 90TH PL SUITE 105 SCOTTSDALE, AZ 85255 | $411K |
| LIPSCOMB & PITTS EIN 62-0533337 INSURANCE AGENT | Insurance agents and brokers Service code 22 | 2670 UNION AVE EXT, SUITE 100 MEMPHIS, TN 38112 | $62K |
| CIGNA BEHAVIORAL HEALTH INC EIN 41-1648670 CONTRACT ADMIN | Participant communication; Float revenue; Claims processing; Other services; Direct payment from the plan; Contract Administrator Service code 12 | 11095 VIKING DRIVE, SUITE 350 EDEN PRAIRIE, MN 55344 | $18K |
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 | 5,171 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 28 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 5,199 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 4,789 | $4.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 4,789 | $4.2M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 4,789 | $4.2M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 6,498 | $1.2M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,398 | $571K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,290 | $792K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 4,789 | $4.2M |
| Other(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 4,789 | $4.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,498 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.