| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 | 400 HIGHWAY 169 SOUTH SAINT LOUIS PARK, MN 55426 | HARTFORD LIFE AND ACCIDENT | $30K | — | $30K | 8.19% |
| WELLS FARGO INSURANCE SERVICES3 | 150 NORTH MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | HARTFORD LIFE AND ACCIDENT | — | $6K | $6K | 1.63% |
No Schedule C service providers reported on this filing.
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 | 648 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 657 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF SOUTH DAKOTA | 1,282 | $535K |
| Vision | VISION SERVICE PLAN | 588 | $93K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 575 | $364K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 575 | $364K |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 648 | $394K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,282 | — |
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.