Form 5500 · Employee benefit plan · EDEN PRAIRIE, MN
ARCSERVE LLC
The filing calls this plan ARCSERVE LLC HEALTH AND WELFARE BENEFIT PLAN.
Public Form 5500 records show how ARCSERVE LLC of EDEN PRAIRIE, MN, a information and media employer, structures its employee benefits. Its broker of record is COTTINGHAM & BUTLER. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 47-1155028 · plan 501 · plan year 2024, filed Sep 30, 2025
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
All 2 insured contracts are health coverage, split across CIGNA HEALTH AND LIFE INSURANCE COMPANY and SELECTHEALTH.
Reported premium across the insured contracts is $2,204,697, with $32,492 in disclosed broker commissions — about 1.5% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
COTTINGHAM & BUTLER is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.
Two carriers split the book: CIGNA HEALTH AND LIFE INSURANCE COMPANY and SELECTHEALTH.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| SELECTHEALTH | Health | 74 | Jan 1, 2025 | $655,828 | $32,492 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health | 92 | Jan 1, 2025 | $1,548,869 | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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