| 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 | — | $6K | $6K | 1.63% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 0.50% |
| WILLIS TOWERS WATSON US LLC3 | COM LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | MINNESOTA LIFE INSURANCE COMPANY | — | $6K | $6K | 2.22% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE PRUDENTIAL INSURANCE COMPANY EIN 22-1211670 STD/FMLA ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $108K |
| EXPRESS SCRIPTS, INC. EIN 43-1420563 PHARMACY ADMINISTRATOR | Contract Administrator Service code 13 | — | $106K |
| ADURO LIFE EIN 20-1119906 WELL-BEING PROGAM ADMIN | Contract Administrator Service code 13 | — | $54K |
| DDMN ASO, LLC EIN 41-1905554 DENTAL ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $42K |
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 | 1,297 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 22 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,319 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 675 | $135K |
| Life insurance | MINNESOTA LIFE INSURANCE COMPANY | 1,297 | $284K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1 | $69 |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,298 | $378K |
| Stop-loss / reinsurancereinsurance | HEALTHPARTNERS ADMINISTRATORS, INC. | 1,949 | $607K |
| Other(2 contracts, 2 carriers) | MINNESOTA LIFE INSURANCE COMPANY | 1,796 | $354K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,949 | — |
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.