| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE CIMA COMPANIES INC3 | 2750 KILLARNEY DRIVE SUITE 202 WOODBRIDGE, VA 22192 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $104K | — | $104K | 9.12% |
| THE CIMA COMPANIES INC3 | 2750 KILLARNEY DRIVE SUITE 202 WOODBRIDGE, VA 22192 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $15K | — | $15K | 9.05% |
| THE CIMA COMPANIES INC3 | 2750 KILLARNEY DRIVE SUITE 202 WOODBRIDGE, VA 22192 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $10K | — | $10K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACTIVE & FIT EIN 33-0883241 SERVICE PROVIDER | Participant communication; Contract Administrator; Float revenue; Other services; Claims processing; Direct payment from the plan; Non-monetary compensation Service code 12 | 10221 WATERRIDGE CIRCLE SAN DIEGO, CA 92121 | $0 |
| AMPLIFON HEARING HEALTHCARE EIN 85-0437037 SERVICE PROVIDER | Non-monetary compensation; Direct payment from the plan; Contract Administrator; Other services; Participant communication; Named fiduciary; Claims processing; Float revenue Service code 12 | FIFTH STREET TOWERS SOUTH 5TH STREE SUITE 2300 MINNEAPOLIS, MN 55402 | $0 |
| FITBIT EIN 20-8920744 SERVICE PROVIDER | Named fiduciary; Direct payment from the plan; Contract Administrator; Non-monetary compensation; Claims processing; Float revenue; Other services; Participant communication Service code 12 | 199 FREMONT STREET SAN FRANCISCO, CA 94105 | $0 |
| LASIK LCA VISION INC EIN 11-2882328 SERVICE PROVIDER | Float revenue; Other services; Claims processing; Non-monetary compensation; Direct payment from the plan; Participant communication; Contract Administrator Service code 12 | 7840 MONTGOMERY RD CINCINNATI, OH 45236 | $0 |
| OMADA HEALTH INC EIN 45-2355015 SERVICE PROVIDER | Participant communication; Named fiduciary; Non-monetary compensation; Float revenue; Other services; Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | 500 SANSOMEST SUITE 200 SAN FRANCISCO, CA 94111 | $0 |
| SUMMIT HEALTH EIN 20-1908041 SERVICE PROVIDER | Contract Administrator; Direct payment from the plan; Other services; Participant communication; Non-monetary compensation; Claims processing; Named fiduciary; Float revenue Service code 12 | 27175 HAGGERTY ROAD NOVI, MN 48377 | $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 | 215 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 215 | $1.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 166 | $161K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 215 | $1.1M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 215 | $100K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 215 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.