| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN A GUSTAFSON3 | 5119 GLADE ST LINCOLN, NE 68506 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 16.20% |
| JOHN A GUSTAFSON3 | 5119 GLADE ST LINCOLN, NE 68506 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 14.33% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY | 8144 WALNUT HILL LANE 16TH FLOOR DALLAS, TX 75231 | CIGNA LIFE AND HEALTH INSURANCE COMPANY | $991 | — | $991 | 5.00% |
| JOHN A GUSTAFSON3 | 5119 GLADE ST LINCOLN, NE 68506 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 16.35% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MARSH & MCLENNAN AGENCY BROKER | Insurance agents and brokers Service code 22 | 8144 WALNUT HILL LANE 16TH FLOOR DALLAS, TX 75231 | $101K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CARRIER TPA | Non-monetary compensation; Claims processing; Named fiduciary; Participant communication; Float revenue; Other services; Direct payment from the plan; Contract Administrator Service code 12 | — | $68K |
| HEALTH SOLUTION TPA | Claims processing Service code 12 | 11409 CRONHILL DRIVE SUITE M OWINGS MILLS, MD 21117 | $1K |
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 | 228 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 228 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 228 | $70K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 228 | $26K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 228 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 228 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.