| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MOODY INSURANCE AGENCY3 Filed as: MOODY INSURANCE AGENCY INC | 8055 E TUFTS AVE STE 1000 DENVER, CO 80237 | CIGNA HEALTH AND LIFE INSURANCE CO | $2K | — | $2K | 0.33% |
| MOODY INSURANCE AGENCY3 Filed as: MOODY INSURANCE AGENCY INC | 8055 E TUFTS AVE STE 1000 DENVER, CO 80237 | THE HARTFORD | — | — | $0 | 0.00% |
| MOODY INSURANCE AGENCY3 Filed as: MOODY INSURANCE AGENCY INC | 8055 E TUFTS AVE STE 1000 DENVER, CO 80237 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS PROCESSOR | Participant communication; Float revenue; Claims processing; Non-monetary compensation; Contract Administrator; Named fiduciary; Other services; Direct payment from the plan Service code 12 | — | $100K |
| AMPLIFON HEARING HEALTHCARE | Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Named fiduciary; Contract Administrator; Float revenue; Participant communication Service code 12 | — | $0 |
| FIT FOR LIFE | Non-monetary compensation; Direct payment from the plan; Contract Administrator; Other services; Participant communication; Named fiduciary; Claims processing; Float revenue Service code 12 | — | $0 |
| OMADA HEALTH, INC | Named fiduciary; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Participant communication; Other services; Float revenue; Claims processing 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 | 194 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 194 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE CO | 610 | $715K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE CO | 610 | $715K |
| Life insurance | THE HARTFORD | 194 | $146K |
| Short-term disability | THE HARTFORD | 194 | $146K |
| Long-term disability | THE HARTFORD | 194 | $146K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE CO | 610 | $715K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE CO | 610 | $715K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 220 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 610 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.