| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 | 333 W 34TH ST NEW YORK, NY 10001 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $12K | — | $12K | 1.22% |
| THE SEGAL COMPANY3 Filed as: THE SEGAL COMPANY EASTERN | 1920 N STREET NW WASHINGTON, DC 20036 | HARTFORD LIFE AND ACCIDENT | — | $10K | $10K | 1.50% |
| THE SEGAL COMPANY3 | 333 W 34TH STREET, 2ND FLOOR NEW YORK, NY 10001 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $37K | — | $37K | 15.64% |
| THE SEGAL COMPANY3 | 333 W 34TH STREET, 2ND FLOOR NEW YORK, NY 10001 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $29K | — | $29K | 14.99% |
| THE SEGAL COMPANY3 | 2018 POWERS FERRY RD SE ATLANTA, GA 303397200 | VISION SERVICE PLAN | — | — | $0 | 0.00% |
| THE SEGAL COMPANY3 | 2018 POWERS FERRY RD, STE 850 ATLANTA, GA 30330 | MHN SERVICES | $189 | — | $189 | 0.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 58-1640157 NONE | Contract Administrator Service code 13 | P.O. BOX 20643 LEHIGH VALLEY, PA 18002 | $892K |
| US DEPT OF HEALTH & HUMAN RESOURCES EIN 99-9999999 NONE | Other fees Service code 99 | — | $121K |
| EMPLOYEE A EIN 75-2599025 EMPLOYEE | Employee (plan) Service code 30 | — | $109K |
| EMPLOYEE B EIN 75-2599025 EMPLOYEE | Employee (plan) Service code 30 | — | $74K |
| EMPLOYEE C EIN 75-2599025 EMPLOYEE | Employee (plan) Service code 30 | — | $59K |
| SEGAL COMPANY EIN 13-2619259 NONE | Consulting (pension) Service code 17 | — | $53K |
| EMPLOYEE D EIN 86-0572343 EMPLOYEE | Employee (plan) Service code 30 | — | $50K |
| FOUR POINT STAR OPERATING CO. EIN 20-5243946 NONE | Other services Service code 49 | — | $30K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 NONE | Accounting (including auditing) Service code 10 | — | $27K |
| BLAKE & UHLIG EIN 48-0918231 NONE | Legal Service code 29 | — | $23K |
| DYNAMARC EIN 20-3555695 NONE | Other services Service code 49 | — | $18K |
| AT&T EIN 13-4924710 NONE | Other services Service code 49 | — | $12K |
| EMPLOYEE E EIN 86-0572343 EMPLOYEE | Employee (plan) Service code 30 | — | $12K |
| TRUSCRIBE EIN 47-3937630 NONE | Other services Service code 49 | — | $9K |
| ULTIMATE HEALTH RESOURCES EIN 20-5712649 NONE | Other services Service code 49 | — | $7K |
| US TREASURY EIN 99-9999999 NONE | Other fees Service code 99 | — | $5K |
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 | 2,961 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 25 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,986 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL INSURANCE COMPANY | 1,670 | $546K |
| Vision | VISION SERVICE PLAN | 1,539 | $131K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 2,796 | $641K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,678 | $992K |
| Other(4 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 2,796 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,796 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.