| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRION GROUP, INC.3 | 2300 RENAISSANCE BLVD. KING OF PRUSSIA, PA 19406 | AETNA LIFE INSURANCE COMPANY | — | $266 | $266 | 1.38% |
| TRION GROUP, INC.3 | 2300 RENAISSANCE BLVD. KING OF PRUSSIA, PA 19406 | AETNA LIFE INSURANCE COMPANY | — | $210 | $210 | 1.38% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE NORTHERN TRUST COMPANY EIN 36-1561860 TRUSTEE & INVESTMENT ADV | Trustee (directed); Soft dollars commissions; Securities brokerage commissions and fees; Direct payment from the plan; Other investment fees and expenses; Investment management fees paid directly by plan; Investment management; Investment advisory (plan); Other fees; Account maintenance fees; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $66K |
| KPMG LLP EIN 13-5565207 ACCOUNTANT | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $61K |
| CORESOURCE, INC. EIN 35-1846036 THIRD-PARTY ADMINISTRATO | Participant communication; Claims processing; Direct payment from the plan; Contract Administrator; Recordkeeping fees; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $50K |
| BLUE CROSS BLUE SHIELD OF ALABAMA EIN 63-0103830 THIRD-PARTY ADMINISTRATO | Direct payment from the plan; Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Recordkeeping fees; Contract Administrator Service code 12 | — | $25K |
| CROWE HORWATH LLP EIN 35-0921680 FINANCIAL STATEMENT PREP | Consulting (general); Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $22K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 THIRD-PARTY ADMINISTRATO | Direct payment from the plan; Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Recordkeeping fees; Contract Administrator Service code 12 | — | $19K |
| PRIME THERAPEUDICS LLC EIN 26-0076803 PHARMACY BENEFIT MANAGER | Participant communication; Recordkeeping fees; Other services; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 12 | — | $16K |
| EXPRESS SCRIPTS HOLDING COMPANY EIN 22-3461740 PHARMACY BENEFIT MANAGER | Recordkeeping fees; Participant communication; Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $13K |
| ERNST & YOUNG LLP EIN 34-6565596 TAX FORM PREPARER | Direct payment from the plan; Consulting (general) Service code 16 | — | $13K |
| AON CONSULTING EIN 22-2232264 FORM 5500 PREPARER | Consulting (general); Direct payment from the plan Service code 16 | — | $6K |
| COTIVITI HEALTHCARE EIN 46-0634974 OVERPAYMENT RECOVERY FIR | Other services Service code 49 | — | $0 |
| THE RAWLINGS GROUP EIN 31-1563156 OVERPAYMENT RECOVERY FIR | Other services Service code 49 | — | $0 |
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 | 212 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 212 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | AETNA LIFE INSURANCE COMPANY | 150 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 150 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.