| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LIFE AND HEALTH UNDERWRITERS, INC.3 Filed as: LIFE & HEALTH UNDERWRITERS INC | 1500 FIFTH AVE STE 1800 SEATTLE, WA 98101 | CIGNA HEALTH & LIFE INSURANCE COMPANY AND AFFILIATES | $9K | — | $9K | 10.19% |
| LIF & HEALTH UNDERWRITERS INC | 1200 FIFTH AVE STE 1800 SEATTLE, WA 98101 | DELTA DENTAL OF CALIFORNIA | $3K | — | $3K | 3.53% |
| LIFE AND HEALTH UNDERWRITERS, INC. Filed as: LIFE & HEALTH UNDERWRITERS INC | 1200 FIFTH AVE STE 1800 SEATTLE, WA 98101 | DELTA DENTAL OF CALIFORNIA | $446 | — | $446 | 5.00% |
| BB&T INSURANCE SERVICES, INC. Filed as: BB& T INSURANCE SERVICES OF CALIFOR | 750 B STREET STE 2400 SAN DIEGO, CA 92101 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $128 | — | $128 | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CONTRACT ADMINISTRATOR | Named fiduciary; Contract Administrator; Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Float revenue; Participant communication Service code 12 | — | $249K |
| LIFE & HEALTH UNDERWRITERS INC INSURANCE BROKER | Other insurance fees and expenses Service code 73 | 1200 FIFTH AVE STE 1800 SEATTLE, WA 98101 | $40K |
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 | 1,026 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY AND AFFILIATES | 989 | $99K |
| Dental(3 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 1,026 | $91K |
| Vision | VISION SERVICE PLAN | 748 | $21K |
| Prescription drug | CIGNA HEALTH & LIFE INSURANCE COMPANY AND AFFILIATES | 989 | $92K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH & LIFE INSURANCE COMPANY AND AFFILIATES | 989 | $92K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,026 | — |
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.