| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE3 | — | RELIASTAR LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| WILLIS TOWERS WATSON US LLC0 Filed as: TOWERS WATSON DE INC | LOCKBOX #28852 PO BOX 28852 NEW YORK, NY 10087 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 0.42% |
| NONE3 | — | MINNESOTA LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE3 | — | UNITED HEALTHCARE INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE3 | — | MINNESOTA LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| MBA SURETY AGENCY INC/MBA INSURANCE3 | P.O. BOX 1343 JEFFERSON CITY, MO 65102 | ZURICH AMERICAN INSURANCE COMPANY | — | — | $0 | 0.00% |
| MBA SURETY AGENCY INC/MBA INSURANCE3 | P.O. BOX 1343 JEFFERSON CITY, MO 65102 | ZURICH AMERICAN INSURANCE COMPANY | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BANKERS BENEFIT EIN 43-1383648 PARTY-IN-INTEREST | Contract Administrator Service code 13 | PO BOX 1343 JEFFERSON CITY, MO 65102 | $795K |
| DELTA DENTAL OF MO EIN 43-0908349 NONE | Claims processing; Contract Administrator Service code 12 | 12399 GRAVOIS ROAD ST LOUIS, MO 63127 | $75K |
| LEWIS & ELLIS INC EIN 75-1281520 NONE | Actuarial Service code 11 | 11225 COLLEGE BLVD #320 OVOERLAND PARK, KS 66210 | $36K |
| MEDTRAK SERVICES, LLC EIN 36-4221427 NONE | Claims processing Service code 12 | 7101 COLLEGE BLVD, STE 1000 OVERLAND PARK, KS 66210 | $30K |
| CENTRAL BANK EIN 43-0975002 NONE | Custodial (other than securities) Service code 18 | PO BOX 779 JEFFERSON CITY, MO 65102 | $19K |
| WILLIAMS-KEEPERS LLC EIN 43-1126847 NONE | Accounting (including auditing) Service code 10 | 3220 W EDGEWOOD, STE E JEFFERSON CITY, MO 65109 | $17K |
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 | 2,675 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,675 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 704 | $98K |
| Life insurance(2 contracts) | MINNESOTA LIFE INSURANCE COMPANY | 2,054 | $134K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,872 | $464K |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 2,697 | $828K |
| Other(2 contracts) | ZURICH AMERICAN INSURANCE COMPANY | 5,185 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,185 | — |
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.