| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CIGNA3 Filed as: CIGNA VISIONCARE INC. | PO BOX 453099 SUNRISE, FL 33345 | VISION SERVICE PLAN | $4K | $4K | $8K | 3.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS. CO. EIN 59-1031071 NONE | Direct payment from the plan; Float revenue; Non-monetary compensation; Claims processing; Other services; Contract Administrator; Participant communication; Named fiduciary Service code 12 | — | $2.3M |
| EMPLOYEE 1 EIN 84-0456274 NONE | Employee (plan) Service code 30 | — | $251K |
| SEGAL CONSULTING EIN 94-1503999 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $202K |
| EMPLOYEE 3 EIN 84-0456274 NONE | Employee (plan) Service code 30 | — | $117K |
| SPENCER FANE LLP EIN 44-0561981 NONE | Legal; Direct payment from the plan Service code 29 | — | $99K |
| EMPLOYEE 4 EIN 84-0456274 NONE | Employee (plan) Service code 30 | — | $92K |
| EMPLOYEE 2 EIN 84-0456274 NONE | Employee (plan) Service code 30 | — | $89K |
| EVERNORTH BEHAVIORAL HEALTH INC. EIN 41-1648670 NONE | Contract Administrator; Direct payment from the plan; Claims processing; Participant communication Service code 12 | — | $72K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $66K |
| WEX HEALTH INC. NONE | Direct payment from the plan; Claims processing Service code 12 | 700 26TH AVE E WEST FARGO, ND 58078 | $34K |
| RICHMOND CAPITAL MANAGEMENT, INC EIN 54-1288544 NONE | Direct payment from the plan; Investment management Service code 28 | — | $33K |
| INNOVEST PORTFOLIO SOLUTIONS LLC EIN 84-1612955 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $24K |
| SEGAL BRYANT & HAMILL EIN 35-2679129 NONE | Legal; Direct payment from the plan Service code 29 | — | $21K |
| ORRANGE POLITICAL STRATEGIES EIN 87-4401423 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $18K |
| PRINCIPAL LIFE INSURANCE COMPANY EIN 42-0127290 NONE | Trustee (bank, trust company, or similar financial institution); Other fees Service code 21 | — | $12K |
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 | 2,639 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,649 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 336 | $243 |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 5,691 | $1.4M |
| Vision | VISION SERVICE PLAN | 2,426 | $207K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 2,639 | $340K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,691 | — |
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.