| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FROST INSURANCE AGENCY INC3 | 640 TAYLOR ST FORT WORTH, TX 76102 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $55K | $26K | $81K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACTIVE & FIT- AMERICAN SPEACIALTY H EIN 33-0883241 | Named fiduciary; Claims processing; Participant communication; Float revenue; Non-monetary compensation; Direct payment from the plan; Contract Administrator; Other services Service code 12 | 10221 WATERRIDGE CIRCLE SAND DIEGO, CA 92121 | $0 |
| AMPLIFON HEARING HEALTHCARE EIN 85-0437037 | Non-monetary compensation; Claims processing; Float revenue; Named fiduciary; Other services; Participant communication; Direct payment from the plan; Contract Administrator Service code 12 | 5TH ST TOWERS 150 SOUTH 5TH ST 2300 MINNEAPOLIS, MN 55402 | $0 |
| FITBIT EIN 20-8920744 | Claims processing; Direct payment from the plan; Other services; Contract Administrator; Participant communication; Non-monetary compensation; Named fiduciary; Float revenue Service code 12 | 199 FREMONT STREET SAN FRANCISCO, CA 94105 | $0 |
| LASIK- LCA-VISION INC. EIN 11-2882328 | Other services; Float revenue; Participant communication; Non-monetary compensation; Contract Administrator; Named fiduciary; Claims processing; Direct payment from the plan Service code 12 | 7840 MONTGOMERY ROAD CINCINNATI, OH 45236 | $0 |
| OMADA HEALTH, INC. EIN 45-2355015 | Named fiduciary; Claims processing; Participant communication; Float revenue; Contract Administrator; Non-monetary compensation; Other services; Direct payment from the plan Service code 12 | 500 SANSOME ST., #200 SAN FRANCISCO, CA 94111 | $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 | 110 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 110 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 110 | — |
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."
No prospect flags tripped on this filing.