| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMERICAN BENEFITS CONSULTING LLC3 | 99 PARK AVENUE 25TH FLOOR NEW YORK, NY 10016 | MINNESOTA LIFE INSURANCE COMPANY | $1K | — | $1K | 0.56% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 NONE | Participant communication; Named fiduciary; Other services; Non-monetary compensation; Claims processing; Contract Administrator; Float revenue; Direct payment from the plan Service code 12 | — | $80K |
| TOWERS WATSON DELAWARE INC EIN 26-0775680 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $54K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $42K |
| BLUE CROSS/BLUE SHIELD MINNESOTA EIN 41-0984460 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Direct payment from the plan; Other fees; Claims processing; Float revenue Service code 12 | — | $40K |
| AON HEWITT ASSOCIATES LLC EIN 36-2237591 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $29K |
| MILLIMAN EIN 91-0675641 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $14K |
| US BANK EIN 41-1638459 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $12K |
| EXPRESS SCRIPTS INC. EIN 43-1420563 NONE | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $10K |
| CB TRACY EIN 23-2366731 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $6K |
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 | 3,876 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,876 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HIGHMARK | 0 | $228K |
| Dental | DELTA DENTAL | 693 | $88K |
| Vision | VISION SERVICE PLAN | 29 | $2K |
| Life insurance | MINNESOTA LIFE INSURANCE COMPANY | 1,167 | $213K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,167 | — |
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.