| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VISION SERVICE PLAN0 | — | VISION SERVICE PLAN | — | $1K | $1K | 18.64% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS EIN 23-7036156 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $356K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 NONE | Named fiduciary; Other services; Claims processing; Direct payment from the plan; Non-monetary compensation; Participant communication; Float revenue; Contract Administrator Service code 12 | — | $279K |
| THE SEGAL COMPANY EIN 94-1503999 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $85K |
| SPENCER FANE LLP EIN 84-1075194 NONE | Legal; Direct payment from the plan Service code 29 | — | $59K |
| DELTA DENTAL OF COLORADO EIN 84-0568337 NONE | Claims processing; Direct payment from the plan; Insurance services Service code 12 | — | $41K |
| NEEDLES & ASSOCIATES, LLC EIN 51-0435869 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $36K |
| MCMORGAN & COMPANY LLC EIN 52-2334338 NONE | Investment management Service code 28 | — | $29K |
| US BANK EIN 31-0841368 NONE | Direct payment from the plan; Other fees Service code 50 | — | $25K |
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 | 994 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 40 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,034 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 979 | $7K |
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 1,400 | $36K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 1,069 | $541K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 1,400 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,400 | — |
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.