| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMERICAN BENEFITS CONSULTING LLC3 | 101 PARK AVENUE TH FLOOR, NY 10178 | SECURIAN LIFE INSURANCE COMPANY | — | $6K | $6K | 2.75% |
| SURVIVOR OUTREACH SERVICES3 | 2591 DALLAS PARKWAY, SUITE 203 FRISCO, TX 75034 | SECURIAN LIFE INSURANCE COMPANY | — | $594 | $594 | 0.27% |
| WILLIS TOWERS WATSON US LLC Filed as: TOWER WATSON DELEWARE INC. | PO BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN, INC. | $6K | — | $6K | 3.00% |
| AMERICAN BENEFITS CONSULTING LLC3 | 101 PARK AVENUE TH FLOOR, NY 10178 | SECURIAN LIFE INSURANCE COMPANY | — | $3K | $3K | 2.75% |
| SURVIVOR OUTREACH SERVICES3 | 2591 DALLAS PARKWAY, SUITE 203 FRISCO, TX 75034 | SECURIAN LIFE INSURANCE COMPANY | — | $276 | $276 | 0.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWER WATSON DELEWARE INC. | PO BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN, INC. | $867 | — | $867 | 3.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXTEND HEALTH, INC. EIN 26-0775680 NONE | Contract Administrator Service code 13 | — | $57K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $50K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 NONE | Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Named fiduciary Service code 12 | — | $50K |
| MILLIMAN EIN 91-0675641 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $31K |
| BLUE CROSS/BLUE SHIELD MINNESOTA EIN 41-0984460 NONE | Float revenue; Other fees; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 12 | — | $19K |
| FAEGRE BAKER DANIELS LLP EIN 41-0244008 NONE | Legal; Direct payment from the plan Service code 29 | — | $12K |
| RIGHT RX LLC- KEENAN PHARMACY CARE EIN 38-3797947 NONE | Contract Administrator Service code 13 | 707 MIAMISBURG-CENTERVILLE RD 406 DAYTON, OH 45459 | $5K |
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 | 3,886 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,886 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 2 carriers) | HIGHMARK | 334 | $459K |
| Dental(2 contracts) | DELTA DENTAL | 86 | $26K |
| Vision | VISION SERVICE PLAN | 0 | $915 |
| Life insurance(2 contracts) | SECURIAN LIFE INSURANCE COMPANY | 4,809 | $327K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,809 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.