| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMWINS5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | ENVISION INSURANCE COMPANY PRESCRIPTION DRUG PLAN | $17K | — | $17K | 5.42% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INS. SERV. | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | ENVISION INSURANCE COMPANY PRESCRIPTION DRUG PLAN | $10K | — | $10K | 3.26% |
| AMWINS5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | UNITED AMERICAN INSURANCE COMPANY MEDICARE SUPPLEMENT | $14K | — | $14K | 4.48% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | UNITED AMERICAN INSURANCE COMPANY MEDICARE SUPPLEMENT | $8K | — | $8K | 2.68% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 NONE | Insurance services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Investment management fees paid indirectly by plan; Investment management Service code 15 | — | $250K |
| BCBSMN,INC-DBA BLUECROSS BLUESHIELD EIN 41-0984460 NONE | Legal; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other commissions; Insurance agents and brokers; Claims processing; Insurance brokerage commissions and fees; Float revenue; Other fees Service code 12 | — | $202K |
| HESS MORGAN HOUSE LLC EIN 56-2559267 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $35K |
| EXTEND HEALTH, INC. EIN 26-0775680 NONE | Contract Administrator; Consulting (general); Direct payment from the plan Service code 13 | — | $22K |
| BCBSMN INC DBA BLUECROSS BLUESHIELD | Legal; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $18K |
| BAKER TILLY VIRCHOW KRAUSE, LLP EIN 39-0859910 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $16K |
| WELLS FARGO MINNESOTA NA EIN 94-1347393 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Float revenue; Trustee (bank, trust company, or similar financial institution) Service code 15 | — | $16K |
| LOCKTON INVESTMENT ADVISORS, LLC NONE | Direct payment from the plan; Consulting (general) Service code 16 | PO BOX 219153 KANSAS CITY, MO 64121 | $10K |
| MII LIFE, INC. - DBA FURTHER EIN 41-6019132 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $7K |
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 | 1,219 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,219 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITED AMERICAN INSURANCE COMPANY MEDICARE SUPPLEMENT | 126 | $335K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 661 | $467K |
| Prescription drug | ENVISION INSURANCE COMPANY PRESCRIPTION DRUG PLAN | 125 | $320K |
| Stop-loss / reinsurancereinsurance | ENVISION INSURANCE COMPANY PRESCRIPTION DRUG PLAN | 125 | $320K |
| Other | HARTFORD LIFE AND ACCIDENT | 292 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 661 | — |
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.