| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $4K | $4K | 1.54% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $3K | $3K | 1.54% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $929 | $929 | 1.54% |
| TRAVEL INSURED5 | 855 WINDING BROOK DR GLASTONBURY, CT 60603 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $282 | $282 | 30.55% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH USA INC. | DBA TRION GROUP, MMC COMPANY 2300 RENAISSANCE BLVD. KING OF PRUSSIA, PA 19406 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $144 | $0 | $144 | 15.60% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 THIRD PARTY ADMINISTRATO | Insurance services; Float revenue; Contract Administrator; Other fees; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Direct payment from the plan Service code 12 | — | $756K |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 PHARMACY BENEFIT MANAGER | Other services; Direct payment from the plan; Recordkeeping fees; Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Participant communication Service code 12 | — | $160K |
| THE NORTHERN TRUST COMPANY EIN 36-1561860 TRUSTEE, INV. MGMT & ADV | Other investment fees and expenses; Trustee (directed); Investment advisory (plan); Account maintenance fees; Investment management; Investment management fees paid directly by plan; Direct payment from the plan; Trustee (bank, trust company, or similar financial institution); Other fees; Float revenue Service code 21 | — | $129K |
| WILLIS TOWERS WATSON EIN 26-0775680 RX COLLABORATIVE SPONSOR | Other services; Other fees; Direct payment from the plan Service code 49 | — | $100K |
| KPMG LLP EIN 13-5565207 PLAN AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $71K |
| CROWE LLP EIN 35-0921680 FINANCIAL STATEMENT PREP | Direct payment from the plan; Accounting (including auditing); Consulting (general) Service code 10 | — | $10K |
| FIDELITY INV INST OP CO, INC. EIN 04-2647786 RECORDKEEPER | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Participant communication; Recordkeeping fees Service code 15 | — | $10K |
| EY EIN 34-6565596 TAX FORM PREPARER | Direct payment from the plan; Consulting (general) Service code 16 | — | $6K |
| AON CONSULTING, INC. EIN 22-2232264 FORM 5500 PREPARER | Consulting (general); Direct payment from the plan Service code 16 | — | $6K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2,148 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,148 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MICHIGAN | 5,168 | $2.0M |
| Life insurance(3 contracts) | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 698 | $512K |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 134 | $923 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,168 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.