| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 0.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHY ALLIANCE LIFE INSURANCE CO. EIN 86-0257201 NONE | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue; Claims processing Service code 12 | — | $3.6M |
| METROPOLITAN LIFE INSURANCE CO. EIN 13-5581829 NONE | Claims processing; Contract Administrator Service code 12 | — | $514K |
| EXPRESS SCRIPTS EIN 22-3461740 NONE | Contract Administrator Service code 13 | — | $273K |
| DELTA DENTAL OF MISSOURI EIN 43-0908349 NONE | Contract Administrator Service code 13 | — | $269K |
| HYATT LEGAL PLANS, INC. EIN 34-1650967 NONE | Legal; Contract Administrator Service code 13 | — | $214K |
| PAYFLEX SYSTEMS USA INC. EIN 91-1774434 NONE | Contract Administrator Service code 13 | — | $146K |
| VISION SERVICE PLAN EIN 36-3560825 NONE | Contract Administrator Service code 13 | — | $65K |
| TEAMSTERS RX EIN 02-6015031 NONE | Contract Administrator Service code 13 | — | $7K |
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 | 13,269 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 107 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 13,376 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 484 | $7.5M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 33,465 | $4.9M |
| Long-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 33,465 | $6.5M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 33,465 | $4.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 33,465 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.