| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEITH O MOELLER3 Filed as: KEITH O. MOELLER | 225 S 6TH ST STE 2900 MINNEAPOLIS, MN 55402 | NORTHWESTERN MUTUAL | $0 | $13 | $13 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SII INVESTMENTS INC EIN 39-1099262 ADVISOR | Finders' fees / placement fees; Investment advisory (plan) Service code 27 | — | $107K |
| FIDELITY INVESTMENTS INSTITUTIONAL EIN 04-2647786 RECORDKEEPER | Participant loan processing; Recordkeeping fees; Account maintenance fees; Sub-transfer agency fees Service code 37 | — | $9K |
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 | 318 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 128 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 4 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 450 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | NORTHWESTERN MUTUAL | 34 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 34 | — |
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.