| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | PO BOX 8299 DB EB OPERATING ACCOUNT PASADENA, CA 91109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $712 | $712 | 1.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INS COMPANY EIN 59-1031071 CLAIMS PROCESSING | Participant communication; Other services; Contract Administrator; Non-monetary compensation; Named fiduciary; Float revenue; Direct payment from the plan; Claims processing Service code 12 | — | $915K |
| CVS HEALTH EIN 05-0340626 CLAIMS PROCESSING | Claims processing Service code 12 | — | $72K |
| OPTUM EIN 82-4606641 CLAIMS PROCESSING | Claims processing Service code 12 | — | $20K |
| CIGNA | Non-monetary compensation; Claims processing; Contract Administrator; Named fiduciary; Float revenue; Participant communication; Other services; Direct payment from the plan 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 | 1,613 | 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) | 1,613 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,566 | $45K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,983 | $1.2M |
| Vision | VISION SERVICE PLAN | 1,176 | $267K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,613 | $591K |
| Short-term disability(4 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,846 | $512K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,920 | $275K |
| Other(3 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,566 | $92K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,983 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.