| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CIGNA3 Filed as: CIGNA VISIONCARE INC. | PO BOX 453099 SUNRISE, FL 333453099 | VISION SERVICE PLAN | — | $4K | $4K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 NONE | Named fiduciary; Direct payment from the plan; Claims processing; Non-monetary compensation; Contract Administrator; Other services; Float revenue; Participant communication Service code 12 | — | $1.2M |
| FRINGE BENEFIT SERVICE, INC. EIN 84-0620086 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $189K |
| BERENBAUM WEINSHIENK PC EIN 84-1075194 NONE | Legal; Direct payment from the plan Service code 29 | — | $115K |
| THE SEGAL COMPANY INC. EIN 94-1503999 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $83K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 NONE | Participant communication; Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $58K |
| NEEDLES & ASSOCIATES, LLC EIN 51-0435869 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $44K |
| WELLS FARGO BANK EIN 84-6061832 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $34K |
| CORELLIAN SOFTWARE INC. NONE | Other services; Direct payment from the plan Service code 49 | 4440 SW CORBETT AVE., STE 204 PORTLAND, OR 97239 | $24K |
| EGAN PRINTING NONE | Direct payment from the plan; Copying and duplicating Service code 36 | 1245 ELATI ST DENVER, CO 80204 | $9K |
| THOMAS TUTTLE TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 5511 W. 56TH AVE., STE 250 ARVADA, CO 80002 | $6K |
| STEVE CALLAHAN TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 5511 W. 56TH AVE., STE 250 ARVADA, CO 80002 | $6K |
| HOWARD ARNOLD TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 5511 W. 56TH AVE., STE 250 ARVADA, CO 80002 | $6K |
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 | 2,277 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 87 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,364 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 67 | $577 |
| Vision | VISION SERVICE PLAN | 2,160 | $0 |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 2,251 | $315K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,251 | — |
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.