| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AY BENEFITS LLC3 | 7500 OLD GEORGETOWN ROAD 1225 BETHESDA, MD 208146808 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | $16K | — | $16K | 4.01% |
| AY BENEFITS LLC3 | 7500 OLD GEORGETOWN ROAD 1225 BETHESDA, MD 208146808 | VISION SERVICE PLAN | $6K | — | $6K | 6.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 THIRD PARTY ADMINISTRATOR | Direct payment from the plan; Non-monetary compensation; Other services; Contract Administrator; Float revenue; Participant communication; Named fiduciary; Claims processing Service code 12 | 900 COTTAGE GROVE ROAD HARTFORD, CT 06152 | $639K |
| HOMES, LOWRY, HORN AND JOHNSON EIN 54-0975470 AUDITOR | Accounting (including auditing) Service code 10 | 3998 FAIR RIDGE DRIVE FAIRFAX, VA 22033 | $19K |
| VISION SERVICE PLAN EIN 23-7089668 THIRD PARTY ADMINISTRATOR | Insurance agents and brokers Service code 22 | PO BOX 997100 SACRAMENTO, CA 958997100 | $17K |
| AY BENEFITS, LLC INSURANCE BROKER/AGENT | Insurance agents and brokers Service code 22 | 7500 OLD GEORGETOWN ROAD 1225 BETHESDA, MD 20814 | $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 | 923 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 923 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 923 | $390K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 923 | $390K |
| Vision | VISION SERVICE PLAN | 752 | $85K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 923 | $390K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 923 | $390K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 923 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.