| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 301 N. LAKE AVE. SUITE 1000A PASADENA, CA 91101 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $30K | — | $30K | 2.90% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 1285 DRUMMERS LN STE 305 WAYNE, PA 19087 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $22K | — | $22K | 2.11% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SVCS INC | 701 B STREET 6TH FLOOR SAN DIEGO, CA 921011828 | HARTFORD LIFE AND ACCIDENT | — | $51K | $51K | 4.95% |
| BENEFIT ADVISORS SERVICES GROUP LLC3 Filed as: BENEFIT ADVISORS SERVICES GRP | ATTN MARTIN JOHNSON 1125 SANCTUARY PARKWAY STE 300 ALPHARETTA, GA 30009 | HARTFORD LIFE AND ACCIDENT | $10K | — | $10K | 1.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS. COMPANY EIN 59-1031071 CONTRACT ADMINISTRATOR | Claims processing; Non-monetary compensation; Direct payment from the plan; Float revenue; Participant communication; Other services; Contract Administrator; Named fiduciary Service code 12 | — | $627K |
| DELTA DENTAL OF VIRGINIA EIN 54-0844477 BENEFIT ADMINISTRATOR | Contract Administrator Service code 13 | — | $38K |
| EVERNORTH BEHAVIORAL HEALTH,INC. EIN 41-1648670 CLAIMS PROCESSING | Direct payment from the plan; Contract Administrator; Claims processing; Participant communication Service code 12 | — | $15K |
| CIGNA | Float revenue; Named fiduciary; Claims processing; Contract Administrator; Direct payment from the plan; Non-monetary compensation; Other services; Participant communication Service code 12 | — | $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 | 954 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 964 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 935 | $163K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 939 | $1.0M |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 939 | $1.0M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 939 | $1.0M |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,886 | $1.0M |
| Other | HARTFORD LIFE AND ACCIDENT | 939 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,886 | — |
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.