| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HYLANT GROUP INC3 Filed as: HYLANT GROUP | 6000 FREEDOM SQUARE DR STE 400 INDEPENDENCE, OH 441312554 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILATES | -$6 | — | -$6 | -0.00% |
| HEALTHCARE BENEFITS INC3 | 1501 REEDSDALE STREET STE 403 PITTSBURGH, PA 15233 | KAISER FOUNDATION HEALTH PLAN INC | $20K | — | $20K | 6.30% |
| HYLANT GROUP INC3 | 6000 FREEDOM SQUARE DR STE 400 INDEPENDENCE, OH 44131 | KAISER FOUNDATION HEALTH PLAN INC | -$8K | — | -$8K | -2.59% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $959 | $3K | 6.52% |
| DAVID DICKENSON III3 Filed as: DAVID DICKENSON II | 6001 COCHRAN RD STE 400 SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| MCKELVEY, PHILIP, NEILL3 | 600 W LOVELAND AVE STE 5A LOVELAND, OH 45140 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | 1501 REEDSDALE STREET SUITE 403 PITTSBURGH, PA 15233 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $95 | $80 | $175 | 5.53% |
| SAGEWELL PARTNERS INC3 | 1501 REEDSDALE STREET SUITE 403 PITTSBURGH, PA 15233 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $5 | $6 | $11 | 6.15% |
| SAGEWELL PARTNERS INC3 Filed as: SAGEWELL PARTNERS | 1501 REEDSDALE STREET SUITE 403 PITTSBURGH, PA 15233 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $169 | — | $169 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 SERVICES PURSUANT TO ASA | Participant communication; Contract Administrator; Other services; Claims processing; Named fiduciary; Float revenue; Direct payment from the plan; Non-monetary compensation Service code 12 | — | $784K |
| CIGNA BEHAVIORAL HEALTH, INC EIN 41-1648670 CONTRACTED FOR EAP | Direct payment from the plan; Claims processing; Contract Administrator Service code 12 | — | $28K |
| CIGNA | Participant communication; Contract Administrator; Other services; Claims processing; Named fiduciary; Float revenue; Direct payment from the plan; Non-monetary compensation 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 | 1,283 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 115 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,398 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1 | $0 |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILATES | 2,334 | $784K |
| Vision | VISION SERVICE PLAN | 699 | $154K |
| Life insurance(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 230 | $50K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 15 | $3K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILATES | 2,334 | $784K |
| Other(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILATES | 2,334 | $834K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,334 | — |
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.