| 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 | $100K | — | $100K | 11.60% |
| THE CIMA COMPANIES INC3 | 2750 KILLARNEY DRIVE SUITE 202 WOODBRIDGE, VA 22192 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $15K | — | $15K | 9.91% |
| 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 AND FIT AMERICAN SPECIALTY H EIN 33-0883241 SERVICE PROVIDER | Non-monetary compensation; Float revenue; Participant communication; Direct payment from the plan; Named fiduciary; Claims processing; Contract Administrator; Other services Service code 12 | 10221 WATER RIDGE CIRCLE SAN DIEGO, CA 92121 | $0 |
| AMPLIFON EIN 85-0437037 SERVICE PROVIDER | Other services; Float revenue; Contract Administrator; Named fiduciary; Non-monetary compensation; Claims processing; Participant communication; Direct payment from the plan Service code 12 | 150 S 5TH STREET SUITE 2300 MINNEAPOLIS, MN 55402 | $0 |
| FITBIT EIN 20-8920744 SERVICE PROVIDER | Participant communication; Contract Administrator; Float revenue; Other services; Claims processing; Direct payment from the plan; Named fiduciary; Non-monetary compensation Service code 12 | 199 FREMONT STREET SAN FRANCISCO, CA 94105 | $0 |
| LASIK LCA VISION EIN 11-2882328 SERVICE PROVIDER | Other services; Float revenue; Contract Administrator; Named fiduciary; Non-monetary compensation; Claims processing; Participant communication; Direct payment from the plan Service code 12 | 7840 MONTGOMERY ROAD CINCINNATI, OH 45236 | $0 |
| OMADA HEALTH EIN 45-2355015 SERVICE PROVIDER | Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Named fiduciary Service code 12 | 500 SANSOME STREET 200 SAN FRANCISCO, CA 94111 | $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 | 201 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 201 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 160 | $866K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 160 | $147K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 160 | $866K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 201 | $98K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 201 | — |
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.