| 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 | 0.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHY ALLIANCE LIFE INSURANCE CO. EIN 86-0257201 NONE | Float revenue; Other services; Claims processing; Contract Administrator; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $4.4M |
| STAYWELL HEALTH MANAGEMENT, LLC NONE | Direct payment from the plan; Other services Service code 49 | 3000 AMES CROSSING ROAD SUITE 100 ST. PAUL, MN 55121 | $484K |
| US WELLNESS, INC. NONE | Direct payment from the plan; Other services Service code 49 | 20400 OBSERVATION DRIVE SUITE 100 GERMANTOWN, MD 20876 | $313K |
| DELTA DENTAL OF MISSOURI EIN 43-0908349 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $287K |
| EXPRESS SCRIPTS EIN 22-3461740 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $265K |
| HYATT LEGAL PLANS, INC. EIN 34-1650967 NONE | Legal; Direct payment from the plan; Contract Administrator Service code 13 | — | $207K |
| PAYFLEX SYSTEMS USA INC. EIN 91-1774434 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $175K |
| BEST DOCTORS, INC. NONE | Direct payment from the plan; Other services Service code 49 | 60 STATE STREET SUITE 600 BOSTON, MA 02109 | $160K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 NONE | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $157K |
| VISION SERVICE PLAN EIN 36-3560825 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $66K |
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 | 13,681 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 104 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 13,785 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,341 | $8.0M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 33,559 | $5.6M |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,258 | $437K |
| Long-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 33,559 | $7.1M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 33,559 | $5.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 33,559 | — |
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.