| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| WILLIS TOWERS WATSON US LLC3 | COM LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | MN LIFE INSURANCE COMPANY | $0 | $6K | $6K | 2.34% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHPARTNERS ADMINISTRATORS EIN 41-1629390 CLAIMS ADMINISTRATOR | Float revenue; Other commissions; Contract Administrator; Claims processing; Insurance brokerage commissions and fees; Insurance agents and brokers; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 8170 33RD AVE S BLOOMINGTON, MN 55425 | $508K |
| EXPRESS SCRIPTS, INC. EIN 43-1420563 PHARMACY BENEFIT MGMT | Contract Administrator Service code 13 | 6625 W 78TH ST BLOOMINGTON, MN 55439 | $91K |
| DDMN ASO, LLC - DELTA DENTAL EIN 41-1905554 CLAIMS ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 9304 MINNEAPOLIS, MN 55440 | $51K |
| PRUDENTIAL INSURANCE COMPANY OF AME EIN 22-1211670 STD CLAIMS ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 7639 PHILADELPHIA, PA 19176 | $39K |
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 | 1,528 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,528 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN - VSP | 598 | $146K |
| Life insurance | MN LIFE INSURANCE COMPANY | 1,217 | $249K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1 | $23 |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,218 | $329K |
| Stop-loss / reinsurancereinsurance | HEALTHPARTNERS ADMINISTRATORS, INC. | 1,879 | $632K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,879 | — |
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.