| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SPECIAL RISK INSURANCE SERVICES INC3 | — | HARTFORD LIFE | — | $100K | $100K | 2.70% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXELON BUSINESS SERVICES, LLC EIN 23-2990190 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | — | $265K |
| OPTUMRX EIN 11-2581812 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $98K |
| NORTHERN TRUST COMPANY EIN 36-1561860 TRUSTEE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $95K |
| TEMPO HOLDING COMPANY, LLC CONSULTING | Consulting (general) Service code 16 | 345 PARK AVENUE NEW YORK, NY 10154 | $51K |
| EXTEND HEALTH INC EIN 26-0775680 CONSULTING | Contract Administrator Service code 13 | — | $37K |
| SB & COMPANY, LLC EIN 20-2153727 AUDITOR | Accounting (including auditing) Service code 10 | — | $27K |
| PRUDENTIAL INSURANCE CO. EIN 22-1211670 INVESTMENT MANAGEMENT | Investment management; Investment management fees paid directly by plan Service code 28 | — | $25K |
| KENNEDY CAPITAL MANAGEMENT INC. EIN 43-1225960 INVESTMENT MANAGEMENT | Investment management fees paid indirectly by plan; Soft dollars commissions; Investment management fees paid directly by plan; Investment management Service code 28 | — | $21K |
| ACADIAN ASSET MANAGEMENT, LLC EIN 04-2929221 INVESTMENT MANAGEMENT | Investment management fees paid directly by plan; Investment management; Investment management fees paid indirectly by plan Service code 28 | — | $18K |
| BLACKROCK INSTITUTIONAL TRUST INC EIN 94-3112180 INVESTMENT MANAGEMENT | Investment management fees paid directly by plan; Trustee (discretionary); Investment management; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $9K |
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 | 4,494 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 554 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,048 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE | 4,513 | $3.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,513 | — |
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.