| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH USA INC. DBA TRION GROUP | 2300 RENAISSANCE BLVD. KING OF PRUSSIA, PA 19406 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 6.27% |
| IMG5 | 2960 NORTH MERIDIAN ST. INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $17 | $17 | 0.02% |
| AXA ASSISTANCE, USA5 | 122 S. MICHIGAN AVE., SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $3 | $3 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS BLUE SHIELD EIN 31-1440175 N/A | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Participant communication Service code 12 | — | $290K |
| SEI PRIVATE TRUST COMPANY EIN 04-2452803 TRUSTEE/INV MGMT | Investment management Service code 28 | — | $124K |
| MEDCO HEALTH SOLUTIONS EIN 22-3461740 N/A | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Participant communication Service code 12 | — | $19K |
| MEADEN & MOORE, LTD. EIN 34-1818258 AUDITOR | Accounting (including auditing) Service code 10 | — | $10K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 TRUSTEE/INV MGMT | Trustee (bank, trust company, or similar financial institution); Other investment fees and expenses; Investment management; Recordkeeping and information management (computing, tabulating, data processing, etc.) 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 | 511 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 85 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 596 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 509 | $95K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 509 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.