| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEAVITT GROUP3 | 21820 BURBANK BLVD., STE 300 WOODLAND HILLS, CA 91367 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $34K | — | $34K | 21.46% |
| USI INSURANCE SERVICES LLC3 | 21700 OXNARD STREET, SUITE 1200 WOODLAND HILLS, CA 91367 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $15K | — | $15K | 9.68% |
| LEAVITT GROUP3 | 21820 BURBANK BLVD., STE 300 WOODLAND HILLS, CA 91367 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $14K | — | $14K | 9.91% |
| LEAVITT GROUP3 Filed as: LEAVITT INSURANCE SERVICES | 21820 BURBANK BLVD., STE 300 WOODLAND HILLS, CA 91367 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 15.74% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICE LLC | P. O. BOX 62949 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10 | — | $10 | 0.04% |
| ARROYO INSURANCE SERVICES, INC.3 Filed as: ARROYO INSURANCE SERVICES | 13749 RIVERSIDE DRIVE, STE 204 SHERMAN OAKS, CA 91413 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $245 | — | $245 | 1.67% |
| USI INSURANCE SERVICES LLC3 | P. O. BOX 62949 VIRGINIA BEACH, VA 23466 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $133 | — | $133 | 0.90% |
| LEAVITT GROUP3 Filed as: LEAVITT INSURANCE SERVICE | 21820 BURBANK BLVD., SUITE 300 WOODLAND HILLS, CA 91367 | LIFE INSURANCE OF NORTH AMERICA | $918 | — | $918 | 9.49% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21700 OXNARD STREET, SUITE 1200 WOODLAND HILLS, CA 91367 | LIFE INSURANCE OF NORTH AMERICA | $79 | — | $79 | 0.82% |
| LEAVITT GROUP3 Filed as: LEAVITT INSURANCE SERVICE | 21820 BURBANK BLVD., STE 300 WOODLAND HILLS, CA 91367 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $148 | — | $148 | 9.18% |
| USI INSURANCE SERVICES LLC3 | 21700 OXNARD ST., STE 1200 WOODLAND HILLS, CA 91367 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13 | — | $13 | 0.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 SERVICE PROVIDER | Other fees Service code 99 | — | $47K |
| CIGNA HEALTH & LIFE INSURANCE CO. | Other services; Float revenue; Non-monetary compensation; Direct payment from the plan; Contract Administrator; Claims processing; Participant communication; Named fiduciary 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 | 148 | 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) | 148 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 148 | $158K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 148 | $136K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 148 | $36K |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 148 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 148 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.