Form 5500 · Employee benefit plan · CHANTILLY, VA
COMMUNITY RESIDENCES, INC.
The filing calls this plan COMMUNITY RESIDENCES HEALTH INSURANCE TRUST.
COMMUNITY RESIDENCES, INC. of CHANTILLY, VA is a 233-participant health care and social assistance employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is POTOMAC BASIN GRP ASSOC LLC. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 54-1004092 · plan 501 · plan year 2023, filed Jun 28, 2024
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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
Also declared: death benefits, other welfare.
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.
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
Schedule A lists 7 insured contracts covering health, dental, vision, life and disability; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 298 people.
Reported premium across the insured contracts is $3,197,319, with $46,645 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.
POTOMAC BASIN GRP ASSOC LLC is the broker of record on 6 of the 7 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including CIGNA HEALTH AND LIFE INSURANCE COMPANY, STARMOUNT LIFE INSURANCE COMPANY, UNUM LIFE INSURANCE COMPANY OF AMERICA and UNUM INSURANCE COMPANY. CIGNA HEALTH AND LIFE INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| STARMOUNT LIFE INSURANCE COMPANY | Dental, Vision | 256 | Jan 1, 2024 | $194,273 | $19,427 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 417 | Jan 1, 2024 | $172,852 | $10,888 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA | — | 95 | Jan 1, 2024 | $44,831 | $6,725 |
| UNUM INSURANCE COMPANY | — | 54 | Jan 1, 2024 | $26,287 | $3,943 |
| UNUM INSURANCE COMPANY | — | 66 | Jan 1, 2024 | $21,214 | $2,926 |
| UNUM INSURANCE COMPANY | — | 86 | Jan 1, 2024 | $19,894 | $2,736 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health | 298 | Jan 1, 2024 | $2,717,968 | $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.
Reported to OSHA
Reported to OSHA for 2025: 147 employees, 4 recordable cases, 14 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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