| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHRISTENSEN GROUP INC3 Filed as: CHRISTENSEN GROUP, INC. | 9855 W 78TH ST STE 100 EDEN PRAIRIE, MN 55344 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $23K | $23K | 3.04% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 444 W 47TH ST SUITE 900 KANSAS CITY, MO 64112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $1K | $1K | 0.19% |
| CHRISTENSEN GROUP INC3 Filed as: CHRISTENSEN GROUP, INC. | 9855 W 78TH ST STE 100 EDEN PRAIRIE, MN 55344 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $17K | — | $17K | 9.60% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 444 W 47 ST SUITE 900 KANSAS CITY, MO 64112 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $2K | $5K | 2.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $27K |
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 | 111 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 60 | $757K |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 111 | $177K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 111 | $177K |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 111 | $177K |
| Short-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 111 | $177K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 111 | $177K |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 111 | $177K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 111 | — |
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.