| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 500 W. MONROE STREET, SUITE 3400 CHICAGO, IL 60661 | METROPOLITAN LIFE INSURANCE COMPANY | — | $52 | $52 | 0.00% |
| LOCKTON COMPANIES, LLC3 | 111 E. KILBOURN AVENUE, SUITE 825 MILWAUKEE, WI 53202 | EXPRESS SCRIPTS, INC. | $23K | — | $23K | 5.15% |
| INTEGRO INSURANCE BROKERS3 Filed as: INTEGRO USA INC. | PO BOX 5682 CAROL STREAM, IL 60197 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 0.52% |
| INTEGRO INSURANCE BROKERS3 Filed as: INTEGRO USA, INC. | PO BOX 5682 CAROL STREAM, IL 60197 | HYATT LEGAL PLANS | $7K | — | $7K | 4.70% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS | PO BOX 310502 DES MOINES, IA 50331 | HYATT LEGAL PLANS | $5K | — | $5K | 3.57% |
| INTEGRO INSURANCE BROKERS3 Filed as: INTEGRO USA INC. | 3500 LENOX ROAD NE, SUITE 1600 ATLANTA, GA 30326 | HYATT LEGAL PLANS | $2K | — | $2K | 1.65% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH @WORK SOLUTIONS | PO BOX 10414 DES MOINES, IA 50306 | HYATT LEGAL PLANS | — | $40 | $40 | 0.03% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | PO BOX 10414 DES MOINES, IA 50306 | HYATT LEGAL PLANS | — | $18 | $18 | 0.01% |
| REUBEN WARNER ASSOCIATES, INC.3 | 1655 RICHMOND AVENUE STATEN ISLAND, NY 10314 | FEDERAL INSURANCE COMPANY | $15K | — | $15K | 15.00% |
| INTEGRO INSURANCE BROKERS3 | 3500 LENOX ROAD ATLANTA, GA 30326 | FEDERAL INSURANCE COMPANY | $11K | — | $11K | 11.02% |
| LOCKTON COMPANIES, LLC3 | 111 E. KILBOURN AVENUE, SUITE 825 MILWAUKEE, WI 53202 | FEDERAL INSURANCE COMPANY | $4K | — | $4K | 3.98% |
| LOCKTON COMPANIES, LLC3 | 500 W. MONROE STREET, SUITE 3400 CHICAGO, IL 60661 | METROPOLITAN LIFE INSURANCE COMPANY | — | $52 | $52 | 0.09% |
| LOCKTON COMPANIES, LLC3 | 500 W. MONROE STREET, SUITE 3400 CHICAGO, IL 60661 | METROPOLITAN LIFE INSURANCE COMPANY | — | $52 | $52 | 0.11% |
| REUBEN WARNER ASSOCIATES, INC.3 | 1655 RICHMOND AVENUE STATEN ISLAND, NY 10314 | FEDERAL INSURANCE COMPANY | $429 | — | $429 | 20.02% |
| LOCKTON COMPANIES, LLC3 | 111 E. KILBOURN AVENUE MILWAUKEE, WI 53202 | FEDERAL INSURANCE COMPANY | $321 | — | $321 | 14.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MUTUAL HEALTH SERVICES EIN 34-0648820 CLAIMS ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $372K |
| MERITAIN HEALTH EIN 16-1264154 CLAIMS ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $346K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 DENTAL ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $54K |
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 | 1,542 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 75 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,617 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 6 | $108K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 1,989 | $534K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,801 | $1.4M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,668 | $310K |
| Prescription drug | EXPRESS SCRIPTS, INC. | 235 | $440K |
| Stop-loss / reinsurancereinsurance | PARTNERRE AMERICAN INSURANCE COMPANY | 1,536 | $357K |
| Other(5 contracts, 3 carriers) | HYATT LEGAL PLANS | 1,887 | $350K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,989 | — |
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.