| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEYSTONE BENEFIT GROUP3 | 9310 OLD KINGS RD S 301 JACKSONVILLE, FL 32257 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $37K | $0 | $37K | 12.01% |
| KEYSTONE BENEFIT GROUP3 | 9310 OLD KINGS RD S 301 JACKSONVILLE, FL 32257 | UNITED CONCORDIA INSURANCE COMPANY | $18K | $0 | $18K | 15.00% |
| KEYSTONE BENEFIT GROUP3 | OLD KINGS RD S 301 JACKSONVILLE, FL 32257 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $498 | $5K | 11.22% |
| KEYSTONE BENEFIT GROUP3 | 9310 OLD KINGS RD S 301 JACKSONVILLE, FL 32257 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $451 | $4K | 11.27% |
| KEYSTONE BENEFIT GROUP3 | 9310 OLD KINGS RD S 301 JACKSONVILLE, FL 32257 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $338 | $3K | 11.56% |
| KEYSTONE BENEFIT GROUP3 | OLD KINGS RD S 301 JACKSONVILLE, FL 32257 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $453 | $66 | $519 | 11.12% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 NONE | Other services; Claims processing; Float revenue; Participant communication; Named fiduciary; Non-monetary compensation; Contract Administrator; Direct payment from the plan Service code 12 | 900 COTTAGE GROVE RD BLOOMFIELD, CT 06002 | $20K |
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 | 180 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 181 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 269 | $308K |
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 375 | $117K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 269 | $308K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 180 | $46K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 180 | $36K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 180 | $23K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 269 | $308K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 375 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.