| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DAVIS PACIFIC BENEFITS3 Filed as: DAVIS PACIFIC BENEFITS L | 5525 S 900 E SUITE 100 SALT LAKE CITY, UT 84117 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 3.15% |
| DAVIS PACIFIC BENEFITS3 Filed as: DAVIS PACIFIC BENEFITS L | 5525 S 900 E SUITE 100 SALT LAKE CITY, UT 84117 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 4.41% |
| DAVIS PACIFIC BENEFITS3 Filed as: DAVIS PACIFIC BENEFITS L | 5525 S 900 E SUITE 100 SALT LAKE CITY, UT 84117 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $539 | $539 | 3.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 SERVICE PROVIDER | Other services; Participant communication; Direct payment from the plan; Claims processing; Non-monetary compensation; Float revenue; Named fiduciary; Contract Administrator Service code 12 | — | $13K |
| CIGNA | Non-monetary compensation; Claims processing; Contract Administrator; Named fiduciary; Float revenue; Participant communication; Other services; Direct payment from the plan 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 | 382 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 382 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 680 | $3.4M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 680 | $3.4M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 680 | $3.4M |
| Life insurance(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 680 | $3.6M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $23K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 680 | $3.4M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 680 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.