| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITOL BENEFIT ADVISORS3 | 12021 LAKE RIDGE LANE SENECA, SC 29672 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $8K | — | $8K | 13.93% |
| CAPITOL BENEFIT ADVISORS3 | 8068 RIDGE VALLEY WOODSTOCK, GA 30189 | AMERICAN UNITED LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| CAPITOL ADMINISTRATORS OF THE SE3 | 1080 PEACHTREE STREET NE UNIT 1210 ATLANTA, GA 30309 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 12.65% |
| CAPITOL BENEFIT ADVISORS3 | 8068 RIDGE VALLEY WOODSTOCK, GA 30189 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 13.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITOL BENEFIT ADVISORS BROKER | Insurance agents and brokers; Insurance services Service code 22 | 8068 RIDGE VALLEY WOODSTOCK, GA 30189 | $56K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMIN | Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator; Claims processing; Contract Administrator Service code 12 | — | $49K |
| OMADA HEALTH INC | Float revenue; Named fiduciary; Claims processing; Contract Administrator; Direct payment from the plan; Non-monetary compensation; Other services; Participant communication Service code 12 | — | $0 |
| SECORP INDUSTRIES PARTNERSHIP | Float revenue; Other services; Named fiduciary; Participant communication; Claims processing; Direct payment from the plan; Non-monetary compensation; Contract Administrator 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 | 150 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 101 | $320K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 72 | $55K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 72 | $55K |
| Life insurance(2 contracts, 2 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 150 | $44K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 54 | $40K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 101 | $320K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 101 | $320K |
| Other(2 contracts, 2 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 150 | $44K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 150 | — |
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.