No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ORCHESTRATEHR EIN 27-4567072 TPA | Claims processing; Contract Administrator; Other fees Service code 12 | — | $7K |
| EBENCONCEPTS COMPANY EIN 75-2966596 CONSULTANT | Consulting (general); Consulting fees Service code 16 | — | $2K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 ADMINSTRATOR | Contract Administrator; Claims processing Service code 12 | — | $1K |
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 | 6 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 6 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 6 | $38K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 6 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.