| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROOKS INSURANCE AGENCY3 Filed as: BROOKS INSURANCE AGENCY INC | 1120 MADISON AVE TOLEDO, OH 43624 | CIGNA GROUP INSURANCE | $9K | — | $9K | 7.84% |
| BENEFIT ADVISORS SERVICES3 | 1120 SANCTUARY DRIVE SUITE 375 ALPHARETTA, GA 30009 | CIGNA GROUP INSURANCE | $2K | — | $2K | 2.00% |
| BROOKS INSURANCE AGENCY3 | — | CIGNA GROUP INSURANCE | $7K | — | $7K | 10.00% |
| BROOKS INSURANCE AGENCY3 Filed as: BROOKS INSURANCE AGENCY INC | 1120 MADISON AVE. TOLEDO, OH 43624 | CIGNA GROUP INSURANCE | $5K | — | $5K | 8.00% |
| BENEFIT ADVISORS SERVICES3 | 1120 SANCTUARY PKWY SUITE 375 ALPHARETTA, GA 30009 | CIGNA GROUP INSURANCE | $1K | — | $1K | 2.00% |
| BROOKS INSURANCE AGENCY3 | 1120 MADISON AVE. TOLEDO, OH 43624 | CIGNA GROUP INSURANCE | $363 | — | $363 | 7.99% |
| BENEFIT ADVISORS SERVICES3 | 1120 SANCTUARY PKWY SUITE 375 ALPHARETTA, GA 30009 | CIGNA GROUP INSURANCE | $91 | — | $91 | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFIT MGMT SERVICES, INC EIN 81-0391256 ADMINISTRATION | Contract Administrator Service code 13 | — | $96K |
| AETNA PPO EIN 06-6033492 PPO | Other services Service code 49 | — | $37K |
| EMPLOYEE BENEFIT MGMT SERVICES INC EIN 81-0391256 NEGOTIATIONS | Other services Service code 49 | — | $11K |
| AETNA CASE MANAGEMENT EIN 06-6033492 CASE MANAGEMENT | Other fees Service code 99 | — | $9K |
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 | 240 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 241 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | CIGNA GROUP INSURANCE | 463 | $57K |
| Long-term disability | CIGNA GROUP INSURANCE | 463 | $109K |
| Prescription drug | GERBER LIFE INSURANCE COMPANY | 243 | $262K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | GERBER LIFE INSURANCE COMPANY | 463 | $286K |
| Other(2 contracts) | CIGNA GROUP INSURANCE | 463 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 463 | — |
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.