| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 190 RIVER ROAD FLOOR 1 SUMMIT, NJ 07901 | UNITED HEATLTHCARE INSURANCE COMPANY | $96K | — | $96K | 4.12% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 600 HIGHWAY 169 SOUTH SUITE 1200 ST. LOUIS PARK, MN 55426 | AETNA LIFE INSURANCE COMPANY | $13K | $2K | $15K | 10.42% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | PO BOX 203334 DALLAS, TX 75320 | VISION SERVICE PLAN | $1K | — | $1K | 4.63% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WELLS FARGO INS SERVICE OF NEW YORK BROKER | Insurance agents and brokers Service code 22 | 7 GIRALDA FARMS 2ND FLOOR MADISON, NJ 07940 | $0 |
| WELLS FARGO INSURANCE SERVICES USA EIN 56-1882208 BROKER | Insurance agents and brokers Service code 22 | 600 HIGHWAY 169 SOUTH SUITE 1200 ST. LOUIS PARK, MN 55426 | -$3K |
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 | 595 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 603 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEATLTHCARE INSURANCE COMPANY | 709 | $2.3M |
| Dental | AETNA LIFE INSURANCE COMPANY | 479 | $144K |
| Vision | VISION SERVICE PLAN | 273 | $31K |
| Life insurance | UNITED HEATLTHCARE INSURANCE COMPANY | 709 | $2.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 709 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.