| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 0.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 NONE | Claims processing; Other services Service code 12 | — | $3.3M |
| VITALITY EIN 45-0644624 NONE | Other services Service code 49 | — | $748K |
| QUEST DIAGNOSTICS EIN 38-2084239 NONE | Other services Service code 49 | — | $259K |
| TAKE CARE HEALTH SYSTEM EIN 23-3057155 NONE | Other services Service code 49 | — | $175K |
| UNITED BEHAVIORAL HEALTH DBA OPTUM EIN 94-2649097 NONE | Contract Administrator Service code 13 | — | $165K |
| OPTUMHEALTH BANK EIN 47-0858534 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $147K |
| LIFE INSURANCE CO. OF NORTH AMERICA EIN 23-1503749 NONE | Contract Administrator Service code 13 | — | $96K |
| INFOR EIN 20-3469219 NONE | Other services Service code 49 | — | $71K |
| ERNST & YOUNG LLC EIN 34-6565596 NONE | Consulting (general) Service code 16 | — | $66K |
| WALGREENS EIN 36-1924025 NONE | Other services Service code 49 | — | $32K |
| WILLIS TOWERS WATSON EIN 23-1159360 NONE | Consulting (general) Service code 16 | — | $31K |
| WILLIS OF TENNESSEE EIN 62-1404453 NONE | Accounting (including auditing) Service code 10 | — | $30K |
| MERCER EIN 13-2834414 NONE | Consulting (general) Service code 16 | — | $25K |
| CLARK SCHAEFER HACKETT EIN 31-0800053 NONE | Accounting (including auditing) Service code 10 | — | $18K |
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 | 5,270 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 493 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,763 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 285 | $651K |
| Dental | DELTA DENTAL OF OHIO | 10,886 | $3.7M |
| Vision | COMBINED INSURANCE COMPANY OF AMERICA | 8,885 | $619K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 5,763 | $3.1M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 5,373 | $1.0M |
| Prescription drug | UNITED HEALTHCARE INSURANCE COMPANY | 285 | $651K |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 5,373 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,886 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.