Form 5500 · Employee benefit plan · TORRANCE, CA
PREMIER LACROSSE LEAGUE
The filing calls this plan PREMIER LACROSSE LEAGUE GROUP BENEFITS PLAN.
PREMIER LACROSSE LEAGUE of TORRANCE, CA insures health, dental and vision coverage for its employees, per Schedule A of its Form 5500. Its broker of record is FAIRLY CONSULTING GROUP LLC. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 82-4368095 · plan 502 · plan year 2025, filed Feb 23, 2026
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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
Schedule A lists 2 insured contracts covering health, dental and vision; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 181 people.
Reported premium across the insured contracts is $1,067,946, with $56,427 in disclosed broker commissions — about 5.3% of premium.
The most recent policy period ended in May, and the plan year ends May 31. Group contracts typically renew on that annual cycle.
FAIRLY CONSULTING GROUP LLC is the broker of record on all 2 contracts.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health | 181 | Jun 1, 2025 | $1,006,366 | $50,318 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health, Dental, Vision | 151 | Jun 1, 2025 | $61,580 | $6,109 |
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.
Other plans filed by this employer
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