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| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 INSURANCE CO. | Contract Administrator Service code 13 | — | $55K |
| CIGNA | Contract Administrator; Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Named fiduciary; Float revenue; Participant communication Service code 12 | — | $0 |
| PROFESSIONAL GROUP PLANS, INC INSURANCE CO. | Insurance agents and brokers Service code 22 | 225 WIRELESS BLVD SUITE 200 HAUPPAUGE, NY 11788 | $0 |
| VALLEY INSURANCE SERVICES, INC. INSURANCE CO. | Insurance agents and brokers Service code 22 | 80 EAST RIDGEWOOD AVENUE 1ST FLOOR PARAMUS, NJ 07652 | $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 | 141 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 141 | $1.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 141 | $1.5M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 141 | $1.5M |
| Life insurance | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 141 | $78K |
| Long-term disability | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 141 | $78K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 141 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.