| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | $0 | $1K | 0.46% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 2677 ROCHELLE PLACE SIMI VALLEY, CA 93063 | DELTA DENTAL OF NEW JERSEY INC. | $5K | $0 | $5K | 3.94% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 141 W GREEN STREET PASADENA, CA 91105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 7.96% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 141 W GREEN STREET PASADENA, CA 91105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 14.53% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 141 W GREEN STREET PASADENA, CA 91105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 14.78% |
| GRIFFIN, STEVEN, RAY3 Filed as: GRIFFIN,STEVEN, RAY | STE 1400 2000 MORRIS AVENUE BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $689 | $0 | $689 | 4.25% |
| WILLIAM FRENCH3 Filed as: WILLIAM THOMAS FRENCH | 141 W GREEN STREET PASADENA, CA 91105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $173 | $0 | $173 | 1.07% |
| GRIFFIN, STEVEN, RAY3 Filed as: GRIFFIN,STEVEN, RAY | STE 1400 2000 MORRIS AVENUE BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 7.87% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 2677 ROCHELLE PLACE SIMI VALLEY, CA 93063 | VISION SERVICE PLAN | $568 | $0 | $568 | 5.27% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 2677 ROCHELLE PLACE SIMI VALLEY, CA 93063 | VISION SERVICE PLAN | $470 | $0 | $470 | 5.31% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 2677 ROCHELLE PLACE SIMI VALLEY, CA 93063 | VISION SERVICE PLAN | $24 | $0 | $24 | 25.26% |
| M FINANCIAL HOLDINGS INC3 Filed as: FM FINANCIAL SERVICES, INC. | 2677 ROCHELLE PLACE SIMI VALLEY, CA 93063 | VISION SERVICE PLAN | $1 | $0 | $1 | 7.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CONTRACT ADMIN | Contract Administrator Service code 13 | — | $13K |
| WEX HEALTH INC. EIN 06-1593514 CONTRACT ADMIN | Contract Administrator Service code 13 | — | $2K |
| CIGNA | Other services Service code 49 | — | $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 | 262 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 268 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NEW JERSEY INC. | 396 | $118K |
| Vision(4 contracts) | VISION SERVICE PLAN | 39,616 | $20K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 261 | $96K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 261 | $57K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 70 | $34K |
| Stop-loss / reinsurancereinsurance(2 contracts) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 184 | $792K |
| Other(5 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 261 | $162K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 39,616 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.