| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BRIAN SHIELDS3 | 7325 BEAUFONT SPRINGS FR RICHMOND, VA 23225 | DELTA DENTAL OF VIRGINIA | $60 | — | $60 | 0.03% |
| INSURANCE OFFICE OF AMERICA3 | NATIONAL HEADQUARTERS ALTAMONTE SPRINGS, FL 32716 | EYEMED VISION CARE | $3K | — | $3K | 9.86% |
| INSURANCE OFFICE OF AMERICA3 | 4915 W CYPRESS ST SUITE 100 TAMPA, FL 33607 | UNUM LIFE INSURANCE COMPANY | $3K | — | $3K | 62.17% |
| JAMES A SCOTT & SON INC3 Filed as: JAMES A SCOTT & SON | PO BOX 603438 CHARLOTTE, NC 28260 | UNUM LIFE INSURANCE COMPANY | $98 | — | $98 | 1.81% |
| INSURANCE OFFICE OF AMERICA3 | 4915 W CYPRESS ST SUITE 100 TAMPA, FL 33607 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 36.65% |
| JAMES A SCOTT & SON INC3 Filed as: JAMES A SCOTT & SON | PO BOX 603438 CHARLOTTE, NC 28260 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $44 | — | $44 | 1.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA LIFE AND HEALTH INSURANCE CO EIN 59-1031071 CLAIMS ADMINISTRATOR | Float revenue; Non-monetary compensation; Direct payment from the plan; Named fiduciary; Participant communication; Contract Administrator; Other services; Claims processing Service code 12 | — | $204K |
| CIGNA | Direct payment from the plan; Named fiduciary; Participant communication; Investment advisory (participants); Other services; Claims processing; Non-monetary compensation; Contract Administrator; Float revenue Service code 12 | — | $2K |
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 | 430 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 432 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF VIRGINIA | 590 | $176K |
| Vision | EYEMED VISION CARE | 424 | $30K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY | 326 | $46K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY | 22 | $0 |
| Long-term disability | UNUM LIFE INSURANCE COMPANY | 326 | $21K |
| Stop-loss / reinsurancereinsurance | CIGNA LIFE AND HEALTH INSURANCE COMPANY | 553 | $525K |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY | 326 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 590 | — |
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.