| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GW MOUNTCASTLE AGENCY INC.3 | 307 WEST CENTER ST LEXINGTON, NC 27292 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $40K | — | $40K | 18.55% |
| DIGITAL INSURANCE LLC3 | 899 CASSATT RD 400 BERWYN PARK, STE 200 BERWYN, PA 19312 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 0.96% |
| EBENCONCEPTS COMPANY3 | 15305 DALLAS PARKWAY STE 800 ADDISON, TX 75001 | EYEMED VISION CARE OBO THE FIDELITY SECURITY LIFE INSURANCE COMPANY | $5K | — | $5K | 17.84% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 ADMINISTRATOR | Contract Administrator; Non-monetary compensation; Other services; Direct payment from the plan; Claims processing; Named fiduciary; Participant communication; Float revenue Service code 12 | — | $154K |
| EBENCONCEPTS COMPANY EIN 75-2966596 CONSULTANT | Other fees; Consulting (general) Service code 16 | — | $60K |
| FLORES AND ASSOCIATES EIN 56-1542307 COBRA ADMINISTRATOR | 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 | 977 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 977 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 906 | $1.0M |
| Vision | EYEMED VISION CARE OBO THE FIDELITY SECURITY LIFE INSURANCE COMPANY | 500 | $25K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 977 | $216K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 977 | $216K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 906 | $1.0M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 977 | $216K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 977 | — |
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.